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