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Wheelchair Seating for Elders

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Presentation on theme: "Wheelchair Seating for Elders"— Presentation transcript:

1 Wheelchair Seating for Elders
Betsy Willy MA, PT, FCCWS Pathway Health Services And Pat Fritz RN, BC, NHA Mountain Pacific Quality Health-WY

2 Wheelchair Seating for Elders
Betsy Willy MA, PT, FCCWS Pathway Health Services And Pat Fritz RN, BC, NHA Mountain Pacific Quality Health-WY

3 Why Wheelchair Seating?
Prevention of Falls Prevention of injury from Falls Reduction of response time to rescue

4 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

5 Enhancing Resident Safety
Maintaining Strength Balance Endurance Flexibility Hydration

6 Provide Alternative Seating Options throughout the day

7 Causes of Falls Related to Seating
Unlocked Brakes Over reaching Sliding Tipping chair Unassisted transfers

8 Wheelchair Seat Belt Entrapment Risks
Inappropriate Use Too loose Poor placement Improper attachment to chair

9 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

10 Fit The Chair to Resident and Keep it Well Maintained

11 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

12 Start with Ideal Position

13 Too Wide, Just Right, Too Narrow

14 Seat or Cushion Depth Cushion too short causes coccyx pressure
Cushion too long causes sacral sitting

15 Arm Rest Height Armrest too high – folks tuck arms inside chair arms
Armrest too low – folks will lean sideways seeking support

16 Too Low – lack of support for back
Back of chair Mid scapula - correct Too Low – lack of support for back

17 Footrest 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

18 No Footrests Advantage: Disadvantage
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

19 Tall lean folks require deeper higher seat with a taller back to avoid falling forward from chair
Chair too small Correct

20 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

21 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

22 Over Reaching will Tip Wheelchair
Avoid by: Increasing seat depth Tipping chair using dual axel components

23 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

24 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

25 Modifications of Chair Back for Kyphotic Backs
Surround Back Molded Back

26 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

27 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

28 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

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