Download - Environmental Factors
DAILY LIVING SKILLS
Environmental Factors
OTA Can collect data in the following areas:
Sensory skills Tactile to assess sensation and determine degree of
impairment which can influence safety in the manipulation of devices.
Visual perceptual processing skills Visual motor perception
Musculoskeletal skills ROM, strength and endurance to assess if client is
physically able to use devices.
OTA Can collect data in the following areas:
Neuromuscular skills Tone, coordination, to assess mobility and
environmental manipulationCognitive skills
Follow directions, judgment, to assess if client is aware of limitations and able to recall directions to control devices safely.
Psychosocial skills Social support, to assess if the client can ask for
assistance when needed.
Wheelchair Setting and Positioning
Promote comfort during upright ADLPromote functional postureFacilitate UE function which occurs with
proper trunk supportPromote social acceptance by allowing eye
contactDecrease pain by properly supporting limbsFacilitate mobility
Wheelchair components
Armrest Fixed: minimal benefit; seen in older w/c or rentals Detached: helpful for transfers Height adjustable: eases transfers, and provides
better support of a lap tray. Desk arms: allow for moving closer to work stations Full arms: for holding a lap tray Wraparound: space saver, reduces width of the chair
by 1 inch
Wheelchair components
Leg rests Fixed: minimal benefit Swing away: allows for feet to be placed on the
ground for transfers Detachable: allows for a safe path for transfers Elevating: to control edema and
Wheelchair components
Foot plates Fixed Swing-away: allows for feet to touch the floor Heel loops: prevent foot from slipping in a posterior
dirction Ankle straps: prevents slipping
Wheelchair components
Frame Fixed: older w/c or sports chairs Folding: easy storage and facilitates mobility in
community Weight: ultra light, active duty lightweight,
lightweight, standard and heavy duty frame The lighter the greater the ease
Additional Attachments Additional Attachments
Anti-tippers Negative: can get caught on
curbsSeatbelts
Safety Attach at hip level
Harnesses Position for lack of trunk
controlArm troughs
Position a flaccid UE/prevent edema
Lapboards Working table top
Head supports Improve eye contact Improved
communication Feeding
Mobile arm support UE for proximal
weakness
Wheelchair components
Seat Width Seat Depth
Measure widest point across hips and add 2”.
Allow clearance on the sides to prevent friction and rubbing.
Allows client to wear heavier clothing.
Weight shifting
Measure from post. Buttocks to the popliteal fossa and subtract 2” bilaterally.
Prevents rubbing and potential decubitis to posterior knee region
Wheelchair Components
Back Height Back Height
Based on need for postural stability
Based on need for UE control
I w/c propulsionLower back height can
increase functional mobility
Higher back height for poor trunk control
Measure from seat surface upward to Mid back under
scapula Mid-scapula/axilla Top of shoulder
Wheelchair components
Seat Height Armrest Height
Knees and ankles 90 degrees
Footrest 2” clearance from the floor
Standard height 20”Hemi-height 17.5”Super-low 14.5”
Shoulders neutral Arms hanging at the
sidesElbow flexed at 90
degreesToo low will encourage
forward postureToo high will encourage
shoulder elevation.
Wheelchair components
Types of Wheelchairs
Reclining back For clients unable to I maintain an upright sitting position
Tilt in space Indicated for pressure relief Clients with extensor tone
One arm drive, hemi chair, amputee frame and powered chairs Recreational
For use in sand, mud, snow and offroad Sports Stander
Designed for the client to change seat height or elevate standing position Stair climbing
Designed to navigate stairs while balancing on two wheels Bariatric
Assist mobility for obese clients
Seating and Positioning
Goals Provide stability, control and comfort Promote proximal stability Decrease the risk of muscle contractures, deformity,
decubiti Increase sitting tolerance and energy level Allow for pressure relief Allow for proper positioning and correct alignment of
trunk and extremities
Linear Contoured/custom-contoured
Flat, non-contourCustomFirm, rigidGood for active
clients, I transfers, or clients with minimal musculoskeletal involvement.
Ergonomically supports client
Provides excellent supportEnhances postural
alignmentDecreased abnormal
postureProvides pressure reliefGood for clients with
moderate to severe CNS dysfunction.
Style of Seating
Major styles and Accessories for Seating System
Solid wood insertLumbar back supportFoam cushionContoured foam cushionPressure relief cushion
Fluid Air
Lateral supports
Ambulation Aids Ambulation Aids
Orthotic devices AFO KAFO HKAFO
Canes Straight: one leg Wide base quad cane
(WBQC): 1 shaft connected to 4-pronged base
Narrow base quad cane (NBQC): prongs are closer together
Walkers Standard: fair
balance/ability to lift device with UE
Hemi: client can’t use 2 hands
Side stepper: situated on non-affected side
Rolling: unable to lift do to UE weakness
Functional Mobility Aids
Bed mobility S/P THR
RollingBridgingSide-lyingSupineSitting
Do not roll on the non-operated side. (results in IR of operated hip which may cause dislocation)
Requires abductor pillow to prevent adduction.
Bed Mobility
S/P CVA S/P Amputation
Educate regarding proper positioning of UE to increase awareness, minimize pain, decrease swelling, and promote normal tone.
May require pillow b/w knees while in sidelying for comfort.
Require training regarding use of pillows to prevent edema.
Need training on passive stretching to residual limb while in bed to prevent contractures
Bed Mobility
Bed mobility aids
Hospital beds Bedrails Elevating head and foot surfaces
Trapeze frame Hoyer liftBed pans and urinals
Transfers
Use proper body mechanics Broad base of support
Perform transfers safely Use transfer belts Stabilize and lock brakes Swing away leg rests Flip up foot rest Remove armrest
Allow for variability of client and environment Adjust transfer methods to clients strengths and limitations Be aware of different floor and ground surfaces
Transfer Types
Stand pivotSliding board
Clients not able to stand Board is placed under client’s gluteal region during a
weight shift Client uses UE to push buttocks up and slide over If client uses a tenodesis grasp the weight-bearing
should be done with a clenched fists. DependentMechanical liftChair lifts