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

Provide Alternative Seating Options throughout the day

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

Fit The Chair to Resident and Keep it Well Maintained

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

Start with Ideal Position

Too Wide, Just Right, Too Narrow

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

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

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

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

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