Interview Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Physical assessment Physical assessment includes: • identifying the presence and/or risk of pressure sores • identifying the method of mobility • finding out how the wheelchair user sits/posture • taking measurements Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Physical assessment Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Physical assessment To be able to move with as much independence as possible is a basic human right Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Physical assessment Considerations for power mobility • How will the wheelchair user control the wheelchair? • hand/arm, head/neck, mouth, foot, other motor points • Diagnosis/disease progression • Cognition • Vision • Environment • ADL
Physical Assessment - Posture Determine how much postural support needed by: • observing sitting posture without support • doing a pelvis and hip posture screen • simulating the support needed with hands • taking measurements Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Posture Record posture to: • remember findings after Ax • track changes over time Record by: • describing in words • drawing a picture • taking photographs Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Posture • Flexible posture – provide support to maintain neutral • Flexible part way to neutral posture – provide support to achieve as close to neutral as is comfortable and functional • Fixed posture – provide support to accommodate Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Posture • Curves of the spine – cervical – Thoracic – Lumbar • Pelvis landmarks – Ischial tuberosities (ITs) – Anterior superior iliac spine (ASIS) – Posterior superior iliac spine (PSIS) Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Posture – sagittal view • trunk upright • back following natural curves • ear, shoulders and hips in line • hips bent to 90° • knees bent to 90° • ankles bent to 90 ° • feet supported Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Posture – frontal view • pelvis level • shoulders level • legs in line or slightly abducted • head midline and balanced over the body Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Posture – transverse view • pelvis level • shoulders level • hips, knees and ankles in line or slightly abducted • head midline and balanced over the shoulders Image from ISO 16840 Wheelchair seating — Part 1: Vocabulary, reference axis convention and measures for body segments, posture and postural support surfaces
Posture • Does a change in the posture of the pelvis affect the rest of the body? • What happens to posture when the pelvis is in: • anterior tilt? • posterior tilt? • lateral tilt/pelvic obliquity? • rotation? Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Posture • The posture of the pelvis will always affect the rest of the body • Always begin postural assessment with the pelvis • When providing postural support, support the pelvis first Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Posture Sagittal plane Frontal plane Transverse plane Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013
Sitting posture without support • To understand postural tendencies • To demonstrate a range of different sitting postures • To find the most upright posture that can be safely and comfortably achieved without losing function • Always ensure the wheelchair user is safe and their feet are supported Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Sitting posture without support Describe posture - sagittal plane • anterior, neutral or posterior pelvic tilt • lordosis, neutral trunk or kyphosis • head/neck neutral, in flexion or extension • shoulders forward, neutral or back • thigh to trunk angle Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Sitting posture without support Describe posture - frontal plane • neutral, right or left pelvic obliquity • neutral trunk or scoliosis • head/neck neutral, in right or left side flexion • shoulder height neutral or asymmetric Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Sitting posture without support Describe posture - transverse plane • neutral, right or left forward pelvic rotation • neutral or trunk rotation • head/neck neutral, in right or left rotation • lower extremities neutral or windswept Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Pelvis and hip posture screen • Sitting posture is influenced by what is happening with the pelvis and hips • Screening helps understand how problems around the pelvis or hips affect the wheelchair user’s sitting posture • Supine Ax reduces the impact of gravity allowing further Ax Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Pelvis posture screen • w/c user lies supine, knees slightly bent • assistant holds lower ribs • assessor holds the pelvis with thumbs on ASIS • assessor tries to align the pelvis if not level • assistant reports if the trunk moves - there may be restricted movement • record how close to neutral Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Hip posture screen • assistant holds the pelvis • assessor moves the leg to neutral sitting posture • assistant reports if the pelvis moves • assessor feels how freely the hip moves • repeat on the other side • record with a goniometer Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Recording the pelvis and hip posture screen
Pelvis and hip posture screen • If the pelvis or hip cannot reach neutral, temporary support may be needed to: – help with stability and balance – facilitate completion of Ax – assess the rest of the posture – accommodate for the unlevel pelvis or hips Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Hand simulation • Your hands provide the support that will be provided by the wheelchair and postural supports • Always start at the pelvis • Then the rest of the body – trunk – head and neck – hips and thighs – lower legs – arms Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Recording the hand simulation
Taking measurements • Body measurements relate to the size of the wheelchair and postural supports • To take accurate measurements: – use a firm tape measure – use calipers to increase the accuracy – in posture identified as the most upright, comfortable and functional Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013
Taking measurements • ISO Standardized Measures for Seating Supports and Seated Posture • Standardized measures are important for: – improving communication – reducing inefficiencies – reporting outcomes – justifying cost – doing research Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013
Taking measurements • ISO defines a global coordinate system for quantifying measures of the person and their seating support surfaces • Measures of the person – Relative body segment angles – Linear body measures • Measures of the seating support surface – Relative support surface angles – Linear support surface measures Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013
Relative body segment angles Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013
Thigh to trunk angle Landmarks used: • lateral hip center point ~ greater trochanter (center of rotation) • lateral femoral condyle • lateral lower neck point Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013
Thigh to lower leg angle Landmarks used: • lateral femoral condyle (center of rotation) • lateral hip center point ~ greater trochanter • lateral malleolus Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013
Lower leg to foot angle Landmarks used: • lateral femoral condyle • lateral malleolus • later heel point (center of rotation) • lateral toe point Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013
Relative support surface angles SEAT TO LOWER LEG LOWER LEG SUPPORT/FOOT SUPPORT ANGLE SUPPORT ANGLE Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013
Linear body measures Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013
Linear support surface measures Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013
QUESTIONS?
Step 2: Assessment Practice Session • Meet in Room 750, 10:45 – 12:15 • Break out into 5 Groups – Study Group 1 and 2 = Group 1 – Study Group 3 and 4 = Group 2 – Study Group 5 and 6 = Group 3 – Study Group 7 and 8 = Group 4 – Study Group 9 and 10 = Group 5 • Bring STEP 2 ASSESSMENT FORM – we will be using pages 4 and 5 for the hands on practice session
Case Studies 1:15 – 3:00 • Group 1 – Room 132 • Group 2 – Room 150 • Group 3 – Room 428 • Group 4 – Room 453 • Group 5 – Room 750 • Bring all 3 forms (ASSESSMENT, PRESCRIPTION, FITTING) • 3:00 – 3:15 Break • Meet back in Room 132, 3:15 -4:30
WHEELCHAIR SERVICE STEPS Step 4: Funding Jessica Comay B.Sc.(OT), OT Reg. (Ont.) Assistive Technology Clinic
Step 4: Funding • Considerations for funding needs to begin at the initial assessment • Only when the wheelchair and PSD’s have been prescribed can the cost be accurately estimated • Funding organizations vary across regions
• www.assistivetechnologyclinic.ca
Step 4: Funding • Considerations for funding needs to begin at the initial assessment • Only when the wheelchair and PSD’s have been prescribed can the cost be accurately estimated • Funding organizations vary across regions
Funding Overview in Ontario • Assistive Devices Program (ADP) • Private Insurance • Disease Specific Agencies • Community Agencies
Assistive Devices Program (ADP) • ADP pays 75% of the cost of a mobility device – www.ontario.ca/page/mobility-aids • Who qualifies: – an Ontario resident – have a valid Ontario health card – have a disability requiring the equipment for six months or longer – NOT income dependent
Assistive Devices Program (ADP) What is Covered? • manual wheelchairs • power wheelchairs • power scooters • power add-ons • positioning devices • forearm-crutches • wheeled walkers for adults • pediatric walkers, standers and strollers
Assistive Devices Program (ADP) • How many devices are covered per person? • One device per person every 5 years • Exception: – Type 2 indoor wheeled walker can also be obtained when applying for a wheelchair • Seating and positioning components have a 2 year replacement period
Assistive Devices Program (ADP) • How much is covered? • ADP will pay 75% of the ADP price for mobility device and positioning components • The client must pay the remaining 25% of the cost
Assistive Devices Program (ADP) • ADP covers 100% of the cost, if the client receives financial support from one of these programs: • Ontario Works (OW) • Ontario Disability Support Program (ODSP) • Assistance for Children with Severe Disabilities (ACSD)
Assistive Devices Program (ADP) • Replacement of mobility device before 5 years: • Change in medical condition and/or functional ability • Change in body size • the mobility aid is worn out, and cannot be repaired at a reasonable cost • ADP does not cover costs for devices lost or damaged through misuse or neglect
Assistive Devices Program (ADP) • 3 steps to apply for funding: • Assessment by OT or PT registered with the ADP • Find an ADP authorized vendor • Fill out the application form with the help of the occupational therapist or physiotherapist
Assistive Devices Program (ADP) • Who does not qualify: • Workplace Safety and Insurance Board (WSIB) – receiving financial support from the for the same mobility aid • Veterans Affairs Canada - Group “A” veteran – receiving financial support from Veterans Affairs Canada for the same mobility aid
Not eligible for ADP: WSIB • Workers Safety and Insurance Board (WSIB) – www.wsib.on.ca • 100% of the cost of mobility devices recommended by a WSIB authorized OT or PT • All equipment needs to be approved by a WSIB case coordinator before purchase
Not eligible for ADP: Veterans Affairs Canada • Group “A” clients are those clients who are eligible to receive health care benefits under the Veterans Health Care Regulations that are directly related to their pensioned disability (condition) as there condition was attributable to, or was incurred during special duty service) – http://www.veterans.gc.ca/eng/about- us/policy/document/1197
Secondary Funding • Motor Vehicle Accident – HCAI – Cover the 25% client balance – May cover 100% of the cost of the devices not covered by ADP • Extended Health Care Benefits – All benefits are different – Client needs to check funding benefits
Secondary Funding • MS Society – www.mssociety.ca • Muscular Dystrophy Association of Canada – www.muscle.ca • ALS Society – www.als.ca
Secondary Funding • March of Dimes Canada – www.marchofdimes.ca – Income dependent – Will cover part of the 25% client balance – Will cover the cost of repairs • Easter Seals (<18 years old) – www.easterseals.org • Hardship Fund – Toronto only – Income dependent – 416-397-0330
Secondary Funding • Community Agencies: • Rotary Club – www.rotary.org • Lions Club – www.lionsclub.org • Kiwanis – www.kiwanis.org • Ceridian Cares – www.ceridiancares.ca
Step 4: Funding Summary • Consideration of funding of the wheelchair and PSD’s needs to start at the initial assessment • Eligibility for ADP and other government programs • Funding sources/options are region specific • Be aware of the funding sources in the areas where you work
WHEELCHAIR SERVICE STEPS STEP 5: Product Preparation STEP 7: User Training STEP 8: Maintenance, Repairs, Follow up Andree Gauthier, OT Reg. (Ont.), UHN, Toronto Rehabilitation Institute, Lyndhurst
Recommend
More recommend
