Environmental Factors

1. Environmental Factors Daily Living Skills

2. OTA Can collect data in the following areas: • Sensory skills • Tactile to assess sensation and determine degree of impairment which can influence safety in the manipulation of devices. • Visual perceptual processing skills • Visual motor perception • Musculoskeletal skills • ROM, strength and endurance to assess if client is physically able to use devices.

3. OTA Can collect data in the following areas: • Neuromuscular skills • Tone, coordination, to assess mobility and environmental manipulation • Cognitive skills • Follow directions, judgment, to assess if client is aware of limitations and able to recall directions to control devices safely. • Psychosocial skills • Social support, to assess if the client can ask for assistance when needed.

4. Wheelchair Setting and Positioning Promote comfort during upright ADL Promote functional posture Facilitate UE function which occurs with proper trunk support Promote social acceptance by allowing eye contact Decrease pain by properly supporting limbs Facilitate mobility

5. Wheelchair components • Armrest • Fixed: minimal benefit; seen in older w/c or rentals • Detached: helpful for transfers • Height adjustable: eases transfers, and provides better support of a lap tray. • Desk arms: allow for moving closer to work stations • Full arms: for holding a lap tray • Wraparound: space saver, reduces width of the chair by 1 inch

6. Wheelchair components • Leg rests • Fixed: minimal benefit • Swing away: allows for feet to be placed on the ground for transfers • Detachable: allows for a safe path for transfers • Elevating: to control edema and

7. Wheelchair components • Foot plates • Fixed • Swing-away: allows for feet to touch the floor • Heel loops: prevent foot from slipping in a posterior dirction • Ankle straps: prevents slipping

8. Wheelchair components • Frame • Fixed: older w/c or sports chairs • Folding: easy storage and facilitates mobility in community • Weight: ultra light, active duty lightweight, lightweight, standard and heavy duty frame • The lighter the greater the ease

9. Wheelchair components Additional Attachments Additional Attachments • Anti-tippers • Negative: can get caught on curbs • Seatbelts • Safety • Attach at hip level • Harnesses • Position for lack of trunk control • Arm troughs • Position a flaccid UE/prevent edema • Lapboards • Working table top • Head supports • Improve eye contact • Improved communication • Feeding • Mobile arm support • UE for proximal weakness

10. Wheelchair Components Seat Width Seat Depth Measure widest point across hips and add 2”. Allow clearance on the sides to prevent friction and rubbing. Allows client to wear heavier clothing. Weight shifting Measure from post. Buttocks to the poplitealfossa and subtract 2” bilaterally. Prevents rubbing and potential decubitis to posterior knee region

11. Wheelchair components Back Height Back Height Based on need for postural stability Based on need for UE control I w/c propulsion Lower back height can increase functional mobility Higher back height for poor trunk control • Measure from seat surface upward to • Mid back under scapula • Mid-scapula/axilla • Top of shoulder

12. Wheelchair components Seat Height Armrest Height Knees and ankles 90 degrees Footrest 2” clearance from the floor Standard height 20” Hemi-height 17.5” Super-low 14.5” Shoulders neutral Arms hanging at the sides Elbow flexed at 90 degrees Too low will encourage forward posture Too high will encourage shoulder elevation.

13. Types of Wheelchairs • Reclining back • For clients unable to I maintain an upright sitting position • Tilt in space • Indicated for pressure relief • Clients with extensor tone • One arm drive, hemi chair, amputee frame and powered chairs • Recreational • For use in sand, mud, snow and offroad • Sports • Stander • Designed for the client to change seat height or elevate standing position • Stair climbing • Designed to navigate stairs while balancing on two wheels • Bariatric • Assist mobility for obese clients

14. Seating and Positioning • Goals • Provide stability, control and comfort • Promote proximal stability • Decrease the risk of muscle contractures, deformity, decubiti • Increase sitting tolerance and energy level • Allow for pressure relief • Allow for proper positioning and correct alignment of trunk and extremities

15. Style of Seating Linear Contoured/custom-contoured Flat, non-contour Custom Firm, rigid Good for active clients, I transfers, or clients with minimal musculoskeletal involvement. Ergonomically supports client Provides excellent support Enhances postural alignment Decreased abnormal posture Provides pressure relief Good for clients with moderate to severe CNS dysfunction.

16. Major styles and Accessories for Seating System • Solid wood insert • Lumbar back support • Foam cushion • Contoured foam cushion • Pressure relief cushion • Fluid • Air • Lateral supports

17. Functional Mobility Aids Ambulation Aids Ambulation Aids • Orthotic devices • AFO • KAFO • HKAFO • Canes • Straight: one leg • Wide base quad cane (WBQC): 1 shaft connected to 4-pronged base • Narrow base quad cane (NBQC): prongs are closer together • Walkers • Standard: fair balance/ability to lift device with UE • Hemi: client can’t use 2 hands • Side stepper: situated on non-affected side • Rolling: unable to lift do to UE weakness

18. Bed Mobility Bed mobility S/P THR Rolling Bridging Side-lying Supine Sitting Do not roll on the non-operated side. (results in IR of operated hip which may cause dislocation) Requires abductor pillow to prevent adduction.

19. Bed Mobility S/P CVA S/P Amputation Educate regarding proper positioning of UE to increase awareness, minimize pain, decrease swelling, and promote normal tone. May require pillow b/w knees while in sidelying for comfort. Require training regarding use of pillows to prevent edema. Need training on passive stretching to residual limb while in bed to prevent contractures

20. Bed mobility aids • Hospital beds • Bedrails • Elevating head and foot surfaces • Trapeze frame • Hoyer lift • Bed pans and urinals

21. Transfers • Use proper body mechanics • Broad base of support • Perform transfers safely • Use transfer belts • Stabilize and lock brakes • Swing away leg rests • Flip up foot rest • Remove armrest • Allow for variability of client and environment • Adjust transfer methods to clients strengths and limitations • Be aware of different floor and ground surfaces

22. Transfer Types • Stand pivot • Sliding board • Clients not able to stand • Board is placed under client’s gluteal region during a weight shift • Client uses UE to push buttocks up and slide over • If client uses a tenodesis grasp the weight-bearing should be done with a clenched fists. • Dependent • Mechanical lift • Chair lifts