Goals include protecting the feet from injury, providing comfort, and distributing pressure as much as possible. Figure 46: Specialized Footplates
Figure 44: Contracture Footrest
Note . From “Footrests,” by Seating Dynamics, n.d.c, retrieved from http://www.seatingdynamics.com/footrests.html . © Seating Dynamics. Reprinted with permission. Goals include decreasing tension in the hamstrings and the resultant pull into a posterior pelvic tilt. It is also important to avoid caster interference and ease transfers as well. Knee extension The knee is extended beyond 90° of flexion either actively or because of loss of range of motion. This posture is typically due to increased extensor tone or loss of range of motion. If this posture is due to increased tone, strategies to reduce tone should be explored. Dynamic options, addressed later in this course, can be very helpful in diffusing force by allowing controlled movement into extension. Strapping the feet to the footplate can limit active extension, if tolerated by the client. If knee flexion range is limited, the footrest hanger must match the available range. If this match cannot be achieved using standard footrest hangers, elevating leg rests may be required (Figure 45). Figure 45: Elevating Leg rests
Arrows in image b indicate footplate movement into dorsiflexion, plantar flexion, inversion, and eversion. Note . Figure 46b is from Bodypoint, n.d., retrieved from http://www.bodypoint.com. © Bodypoint. Reprinted with Permission. Figure 47: Footbox
Note . From Stealth Products, n.d., retrieved from http://www.StealthProducts.com. © Stealth Products. Reprinted with permission
Head Not everyone who uses a wheelchair requires head positioning. Sometimes a head support is required only for safety in transportation if the client is transported seated in his or her wheelchair. Sometimes a head support is required to provide posterior support during tilt or recline. However, many clients do have decreased head control and may require specific seating interventions. Decreased head control When head control is decreased, a client has difficulty bringing his or her head to an upright and aligned posture and maintaining it in that position. Decreased head control may be the result of decreased neck strength, forward flexor tone, or even a visual impairment (specifically, CVI or a vertical midline shift). Interventions for decreased head control primarily involve various styles of posterior head supports (Figure 48); however, many seating strategies can be employed before looking at specific products. It is critical for the pelvis and trunk to be upright and aligned to optimize head balance and position. Tilt and an open seat-to-back angle can reduce the influence of gravity on the head as well. Most of these provide support only at the occiput, but some add a suboccipital support, providing additional support and minimizing hyperextension (Figure 49). Lateral support is also available, as needed (see Figure 49).
Note . From Sunrise Medical, n.d., retrieved from http://www. sunrisemedical.com. © Sunrise Medical. Reprinted with permission. Goals include alleviating the pull on the pelvis and lower leg and accommodating the client in an extended position, as required. Ankle and foot limitations Any limitation in normal ankle and foot position can be caused by tonal patterns, inappropriate postural support, lack of weight-bearing, and surgery, resulting in atypical foot shapes and postures. Angle adjustable footplates (sagittal and frontal planes) are designed to match the angle of the ankle to maximize weight-bearing as a means for intervention. Standard footplates commonly can accommodate limitations in plantar and dorsiflexion. Specialized footplates can also accommodate limitations in inversion and eversion (supination and pronation; Figure 46). If these footplates cannot adequately distribute pressure, then other strategies are required. Footboxes surround the foot to provide protection and support (Figure 47). Additional padding within the footbox or on the footplate is often required to prevent injury to clients who do not wear shoes. Adaptive footwear can also distribute pressure and protect the feet.
Page 37
Book Code: PTNC1023
EliteLearning.com/ Physical-Therapy
Powered by FlippingBook