Wheelchair Positioning: The Extremities
Presented by Michelle L. Lange
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Positioning the upper and lower extremities is addressed after the mat assessment and positioning the pelvis and trunk. This course will review common lower extremity seating challenges including hip extension/flexion, hip abduction/adduction, knee extension/flexion, and issues at the ankles and feet. Upper extremity seating challenges, including destructive postures, uncontrolled movements, self-abusive behaviors, and shoulder instability, will also be addressed. Strategies for addressing each challenge will be presented, including goals of each. This course is applicable to occupational and physical therapists who work with clients using wheelchairs and applies to multiple practice settings.
Learning Objectives
- Apply appropriate wheelchair seating interventions to a client sitting in excessive hip flexion/extension or abduction/adduction
- Apply appropriate wheelchair seating interventions to a client sitting in excessive knee flexion/extension or an asymmetrical ankle or foot position
- Apply appropriate wheelchair seating interventions to a client assuming destructive postures or demonstrating uncontrolled movements of the upper extremities
- Apply appropriate wheelchair seating interventions to a client with shoulder instability
- Implement appropriate wheelchair seating interventions to improve mobility to enhance participation in desired daily occupations and reduce risk for complications such as skin breakdown or limb contractures
Meet your instructor
Michelle L. Lange
Michelle Lange is an occupational therapist with over 38 years of experience and has been in private practice, Access to Independence, for over 19 years. She is a well-respected lecturer, both nationally and internationally, and has authored numerous texts, chapters, and articles. She is the coeditor of Seating and Wheeled…
Chapters & learning objectives
1. Positioning the Lower Extremities: Hip Challenges
Excessive hip flexion that cannot be reduced requires a more closed seat-to-back angle. If the upper legs are forced downward, the pelvis will be pulled into an anterior tilt. Excessive hip extension can lead to a posterior pelvic tilt and requires interventions including a more open seat-to-back angle and dynamic seating. Excessive hip adduction is often seen in conjunction with hip extension and internal rotation. Excessive hip abduction can lead to a seat and wheelchair frame that are wider than the client’s requirements at the hips.
2. Positioning the Lower Extremities: Knee and Foot Challenges
Excessive knee flexion can lead to caster interference with the footplates and impact transfers and ADLs. Excessive knee extension can lead to loss of position and stability and an increase in the overall turning radius of the wheelchair base. If the ankle or foot is not in a neutral alignment, pressure distribution is affected. If the foot does not remain on the footplate, pressure distribution, stability, safety, and function are all compromised. Strategies to address these challenges will be provided.
3. Positioning the Upper Extremities: Destructive Postures and Uncontrolled Movements
Some clients using wheelchair seating systems assume destructive upper extremity postures, which can lead to loss of range or compromise shoulder integrity. Other clients may have uncontrolled upper extremity movements. This can lead to injury of the client or others, difficulty getting through the environment (such as through doorways), and lack of stability.
4. Positioning the Upper Extremities: Self-Abusive Behaviors and Shoulder Instability
Some clients using wheelchair seating systems display compulsive self- or other-abusive behaviors involving the upper extremities. This can lead to injury of the client and others as well as impact overall function. Seating strategies can be used to limit abusive behaviors, which can, in turn, allow the client to focus on functional activities. If the client has shoulder subluxation or dislocation, the arm must be well supported to prevent further loss of shoulder integrity.
More courses in this series
Wheelchair Positioning: The Pelvis
Michelle L. Lange
Wheelchair Positioning: The Trunk
Michelle L. Lange
Wheelchair Positioning: The Extremities
Michelle L. Lange
Wheelchair Positioning: The Head
Michelle L. Lange
Wheelchair Positioning: Tying It All Together—A Series of Case Studies
Michelle L. Lange