Accessibility
What are the main differences between Accessible and Universal Design?
Accessible design: meets the Minimum Standard for Accessibility and often involves making changes to Existing Structures
Universal Design: allows the Greatest Extend of access and is often applied from Inception
What are the specs of a K0003 wheelchair (weight, height, width, depth)
Light weight wheelchair
Weight: Under 26 lbs
Height: 17-21 inches
Width: 16-20 inches
Depth: 16-18 inches
Best for individual who needs lighter chair for propulsion or needs larger accommodations for seat width and depth
What are the 4 cardinal signs of Parkinson's Disease
Resting Tremor (pill rolling)
Bradykinesia (slow or lack of movement)
Rigidity (lead pipe or cog wheel)
Postural instability (70% of pts. fall annually)
What is Uhthoff's Phenomenon?
The demyelination of fibers in the CNS causes increased sensitivity to small elevations in core body temperature.
What are the MRADL's needed in a letter of medical necessity?
toileting
grooming
dressing
bathing
feeding
What are the ADA requirements for standard wheelchair accessibility? (seat width, chair width and occupied width)
Seat Width of 18 inches
Chair width of 26.5 inches
Occupied width of 36 inches
Your patient needs a power wheelchair that is good in the Portland rain, can get them up and down the hill to their home and can manage their gravel driveway. What Drive type would be best for this individual
Rear Wheel Drive
: good for uphill, good stability, good for rough terrains, largest turning radius and good speed
Deep Brain Stimulation is not indicated for patients looking to decrease what Parkinson's symptoms.
What medications are commonly prescribed for MS patients? (CRAB)
--> Beta-interferons: Betaserons, Avonex, Rebif
--> Copaxone
What are the cut off scores for Parkinsons:
- MiniBESTest?
- 5x STS?
- TUG?
MiniBESTest: less than 19
5xSTS: more than 16 seconds
TUG: more than 15 seconds
Stairs should be no more than ___ inches high and at least ____ inches deep
Stairs also need railings to be between _____ height off the ground and extending ____ inches at the top and bottom.
no higher than 7 inches and at least 11 inches deep
between 34-38 inches off the ground and extending 12 inches at top and bottom
What are two pros and one con of a more posterior axle and wheel position on a wheel chair?
Pros: more stable and increased room for pivot transfers
Cons: may increase risk for shoulder injury due to excursion
chair will also be longer
What principles of neuroplasticity should be considered when treating patients with Parkinson's?
Intensity, Force Use (practice at a rate faster than normal), Specific Practice, Complexity, Saliency (meaningful)
List 3 common symptoms of MS (there's more than just 3)
Optic Neuritis
Spasticity
Tremor
Ataxia
Paresthesia
Impaired pain, temperature or light touch
bowel/bladder dysfunction
sexual dysfunction
Your Parkinson's Patient has bilateral impairments, but reactive balance is intact --> they can recover from the pull test. What Hoehn and Yahr stage would you assign your patient?
2.5 = bilateral symptoms with reactive balance (recovery from pull test)
A shelving unit must be between ____ inches off the ground if reaching in front and ____ inches if reaching from the side
between 48 and 15 inches off the ground if reaching forward
between 48 and 9 inches off the ground if reaching to the side
PT's role in wheelchair seating assessment and prescription should consider? (think examination, interprofessional communication, documentation, and education)
1. Examination of ICF (impairments + activity limitations + participation restrictions=mobility needs; as well as personal factors and environmental factors)
2. Working with Vendors and ATP
3. Letter of Medical Necessity
4. caregiver edu, training and follow-up appointment
What are predictors of falls in Parkinson's patients?
Fall in the Previous year (4)
Loss of Arm Swing (4.3)
Each year with the disease (1.3)
Dementia (6.7)
A score of ___ on the four square step test indicates increased risk of falling for adults with MS
12.5 seconds
More than 15 seconds in community dwelling adults
More than 12 seconds in adults with vestibular problems
The EDSS helps to stage MS progression and disability. What would a stage 5 look like?
Stage 5 will not ambulate with aid or rest for 200 meters
How much knee space is needed to be meet ADA standards? from 0inches above ground and 27 inches off the ground?
if 0 inches off the ground there must be 11 inches of knee space (depth)
if 27 inches off the ground there must be 8 inches of knee space (depth)
How should a wheelchair fit an individual? (seat width, depth, height and foot plate)?
Seat width: 1/2 inch on either side
Seat depth: 1 inch from the seat to the back of the knees
Seat height: must fit under a 27 inch table
2 inches from the floor to the foot plate
During the Early (I-II), Middle (III-IV) and Late (V) stages of MS what should be the main focus of intervention (1 from each stage)
Early: muscle strength--> overall increase in activity to decrease fear of falling and aerobic capacity
Middle: Functional Strength--> to maintain posture, balance, gait
Late: Function Strength if possible--> to maintain vital function and prevent contractures
Your patient is able to ambulate with an assistive device and can ambulate for 100m without rest. What is the EDSS score?
A Six
A time of ___ on the four step square test is indicative of fallers for patients with MS. A time of ____ for community dwelling individuals over 65 years old and ____ for vestibular disorder
12.5 +/- 5.7 for adults with MS
over 15 seconds for for adults over 65
over 12 seconds for adults with vestibular disorders