Precautions
What are the WB precautions for external fixation?
What are the mobility precautions?
WB: NWB
Mobility: AAROM, AROM, PROM depending on site of fixation
What are the WB and mobility precautions we should be aware of after a patient receives a pacemaker?
WB: PWB through involved UE
Mobility: No driving, no hyperextension, shoulder flexion>90, carrying loads>10lbs, abduction>90 degrees
What is the sequence of positions to be able to log roll?
Supine --> Hook lying --> Side lying
How do you measure seat depth in a WC?
Measure back of hips to popliteal fold - 2 inches
Beware of sacral sitting
What might happen if the WC seat was too wide or too narrow?
Too wide: poor trunk control, difficult to fit into small spaces
Too narrow: excessive pressure against hips
What are the indications for spinal precautions? What are the WB precautions and mobility precautions?
Fracture, stenosis, disc herniation, scoliosis, mechanical pain
WB: No lifting over 10 lbs
Mobility: NO bending, lifting or twisting (BLT), log rolling is IMPORTANT
What device can you use if a patient can bear some weight on LE's, can flex hips, knees and ankles and maintain sitting balance to perform a trasnfer?
Standing frame- this allows the patient to participate in the transfer process
If a patient wanted something more mobile for their assistive device but still needs some support during ambulation. They are currently using a 4 point walker, what could you have them try out next?
2 wheeled walker --> then maybe a rollator walker if it works well for them
How do you measure seat width on a wheelchair?
Measure distance between the outside edges of hips + 1-2 inches
What would be the consequences of a seat being too shallow or too deep?
Too shallow: lack of support for BLE
Too deep: pressure on popliteal fossa, sacral sitting
If someone has had a CVA, what are the WB precautions and mobility precautions?
WB: NWB if flaccid, PWB if tone is present
Mobility: protect joints around flaccid extremity, provide UE sling if appropriate, locking knee brace or AFO
What is the max amount of time a patient can be in 1 position in bed? What about the max amount of time they can be in 1 seated position?
2 hours max in bed
15 mins max in sitting
A patient states they are fearful of becoming unsteady while walking longer distances. What is the least restrictive AD you could recommend?
Single point cane
How do we measure seat to floor height on a WC?
Measure from sole of shoe to popliteal fold - thickness of cushion + 2 inches (footrest clearance)
What would be the consequences of a seat being too low or too high on a WC?
Too low: difficulty rising from chair, hip flexion contractures
Too high: difficulty fitting under desks/tables
What are some indications for abdominal precautions? What are the WB precautions and mobility precautions?
WB: No lifting heavier than 5-10 lbs
Mobility precautions: Log rolling IMPORTANT!!, abdominal binder
What are the most common type of contractures and where?
Flexion contractures- usually hip or knee flexors
What population are hemi-walkers mostly used with?
After a patient has a stroke, helps with the hemiplegic side
How do we determine seat back height on a WC?
Depends on amount of support needed
Can measure from seat surface to inferior angle of scapula
What if the back height was too high or too low on a WC?
Too high: pressure against axilla, difficulty reaching to push handles
Too low: poor trunk control
When would a patient be put on sternal precautions? What are the WB and mobility precautions?
Indications: CAD, aortic dissection, valve replacement, emergency
WB: no lifting>10 bs, pushing or pulling with entire body weight
Mobility: move in the tube
What are some restraint policies?
Patients should ONLY be restrained by order of physician
Patients/family have to be informed of the reason they are restrained
Patients can only be restrained involuntarily in emergent situations
What are some things we need to consider when prescribing an assistive device?
Availability, Accessibility, Affordability , Adaptability, Acceptability , Quality
AD support, stability, size and comfort
PATIENT SAFETY
How do you measure for armrest position on a WC?
Measure from olecranon to seat + cushion if needed + 1 inch to determine height of armrest
How big should hallways, doorways, ramps and turning spaces be to be adequate for WC accessibility
Hallways: 36 inches wide
Doorways: 32 inches wide
Ramps: 1:12 ratio
Turning space: 60 inches or "T" shaped