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Wheelchair Seating for Elders. Betsy Willy MA, PT, FCCWS Pathway Health Services And Pat Fritz RN, BC, NHA Mountain Pacific Quality Health-WY. Wheelchair Seating for Elders. Betsy Willy MA, PT, FCCWS Pathway Health Services And Pat Fritz RN, BC, NHA Mountain Pacific Quality Health-WY.
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Wheelchair Seating for Elders Betsy Willy MA, PT, FCCWS Pathway Health Services And Pat Fritz RN, BC, NHA Mountain Pacific Quality Health-WY
Wheelchair Seating for Elders Betsy Willy MA, PT, FCCWS Pathway Health Services And Pat Fritz RN, BC, NHA Mountain Pacific Quality Health-WY
Why Wheelchair Seating? • Prevention of Falls • Prevention of injury from Falls • Reduction of response time to rescue
Enhancing Resident Safety • Stable staffing • Units • Neighborhoods • Relationships • Predict behaviors • Ownership of resident’s safety • Caring for your own • All staff involved • Identify high risk • Execute intervention • Vigilance • Visual supervision • Mobile work stations • Handoff Communications • Shift changes • Admission • Transfer unit to unit • Transfer to ED • Discharge to home
Enhancing Resident Safety • Maintaining • Strength • Balance • Endurance • Flexibility • Hydration
Causes of Falls Related to Seating • Unlocked Brakes • Over reaching • Sliding • Tipping chair • Unassisted transfers
Wheelchair Seat Belt Entrapment Risks • Inappropriate Use • Too loose • Poor placement • Improper attachment to chair
Why DO folks attempt to get out of their chairs? • Uncomfortable • Pain • Fatigue • Boredom • Lack of engagement with others • Left for long periods in front of TV or in their rooms • Confusion • Agitation/anxiety
Basic Principles for Wheelchair Seating • Knees should be level with hips – thighs horizontal to floor • Feet flat on floor if self propelling • Wheelchair Back comes up to mid scapula • Elbows rest on armrests without leaning • Two finger rule • Width: There should be two fingers of space between hip and side arm • Seat depth: Two fingers of space behind back of calf and edge of seat
Seat or Cushion Depth Cushion too short causes coccyx pressure Cushion too long causes sacral sitting
Arm Rest Height Armrest too high – folks tuck arms inside chair arms Armrest too low – folks will lean sideways seeking support
Back of chair Mid scapula - correct Too Low – lack of support for back
If too Low the elder will Slide into sacral sitting Arch Low Back causing pain If too Short Pressure on Coccyx Elevating footrests Pulls individual into sacral sitting Special Order footrests are available to accommodate “Foot drop” contractures Supination or Pronation foot contractures Knee Flexion Contractures Footrest
Advantage: If correct wheelchair seat height the elder can propel self Disadvantage When pushed, risk of trauma to feet Seat height too high with no foot rests Slides into sacral sitting causing fall risk Arches low back causing pain and discomfort No Footrests
Tall lean folks require deeper higher seat with a taller back to avoid falling forward from chair Chair too small Correct
Morbidly Obese Folks • Provide extra depth wheelchair seat • Support low back above the buttocks • Provide extra width seat • Use heavy duty chair frame • Consider large wheels in front of chair with casters in back for easier propelling
Gravity Assisted Seating to prevent sliding from chair • Seat the pelvis down and back into the chair • Tip chair using dual axel option • Increase seat depth
Over Reaching will Tip Wheelchair • Avoid by: • Increasing seat depth • Tipping chair using dual axel components
Kyphotic (Curved) Back • Causes: • Sliding from chair • High pressure points on spinal processes and coccyx • Poor eye contact due to facial orientation • Back pain due lack of low back support
Seating for Kyphotic Back • Tip front of seat up using dual axel component to allow eye contact and reduce sliding • Replace back upholstery with molded or surround back option to reduce pressure and pain • Increase seat depth to support low back
Modifications of Chair Back for Kyphotic Backs Surround Back Molded Back
Avoid Unplanned Wheelchair Movement • Ensure brakes are well maintained • Use Anti – Rollback brake device for individuals who forget to lock brakes • Ensure anti-rollback device is correctly adjusted to avoid excessive pressure
Exhaustion causes falls and judgment errors • Cardio-pulmonary compromised elders • Use lightweight Wheelchair • Use Lightweight oxygen tank • Avoid Rugs which create resistance • Keep wheelchair wheels gliding easily
Falls related to Wheelchair seating can often be solved through simple wheelchair adaptations.This material was developed by Betty Willy, PT, Pathway Health Services and reproduced, with permission, by Mountain-Pacific Quality Health, the Medicare quality improvement organization for Montana, Wyoming, Hawaii and Alaska, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Contents presented do not necessarily reflect CMS policy. 9SOW-AS-MQPHF-PS-10-61