Restraint Reduction and Wheelchair Positioning. By Julie Clark PTA/RSM

Transcription

1 Restraint Reduction and Wheelchair Positioning By Julie Clark PTA/RSM

2 Objective This presentation will focus on problem solving wheelchair positioning needs and restraint reduction ideas using real examples completed in our building.

3 Restraint Reduction and Wheelchair Positioning In order to accomplish one you must accomplish the other. Provide a wheelchair that accommodates the way the resident wants to sit verses the way the wheelchair is built Think out side the box when ordering equipment Work on stretching and strengthening programs in therapy Get the families and staff involved and educated on the benefits of restraint reduction and proper positioning

4 Resident #1 Goals: Improve posture in wheelchair to enable residents ability to attend facility activities, prevent falls, decrease muscle strain, improve quality of life by increasing ability to view surroundings and visit with staff Plan: Provide PT for core strengthening and stretching, wheelchair management, and caregiver education on proper positioning,

5 Resident #1 Kyphosis and Sacral Sitting: This resident is weight bearing on one hip with her sacrum nearly off the front of the wheel chair seat. This resident also has Kyphosis This position is also putting stress on her RUE. Notice how much of her femur is past the seat.

6 Frontal View Of Resident #1 Notice the flexed posture with the posterior pelvic tilt. This is the posture I refer to as sacral sitting. This resident s posture also involves extended legs increasing the difficulty to self propel with bilateral feet.

7 Side View Resident #1 Notice the distance from the edge of the wheelchair to the back of her knee. You are also able to see the pressure from the cushion on her thigh. This resident was in a hemi height 16 wide X 18 deep seat.

8 Resident #1 In The New Wheelchair This resident now has a 16 wide X 20 deep seat, super hemi height wheelchair I added a K-Special back, and dumped the seat, along with adding a Skil Care foot rest and a Roho Cushion that measures 20 wide X 16 deep and I turned it sideways.

9 Resident # 1 Front View This photo was taken 2 hours after she had been placed in the wheelchair. She had been to an activity and was able to actively participate. Notice she is not leaning, her legs are supported, and she has a more upright posture.

10 Resident # 2 Goals: Improve residents posture in the wheelchair and remove restraint Progress resident to out of room activities and Provide ST and OT for improved intake and self feeding Plan: PT for core strengthening and stretching, wheelchair management, caregiver education on proper positioning OT for self feeding and BUE strengthening ST for improved oral intake (OT and ST evaluated and treated this resident once the wheelchair and positioning was in place)

11 Resident # 2 This resident is weight bearing on one hip causing her left arm to have increased pressure on it. She is also sacral sitting and has excess femur length past the seat. This resident has severe Kyphosis. She had a restraint on in order to keep her in the wheelchair as she had repeat falls sliding out of the wheelchair.

12 Resident #2 Side View Notice her right hand holding tight to the wheelchair. Due to her kyphosis she is forced to hyper extend her cervical spine in order to see forward. Her spine has multiple pressure spots on the back of the wheelchair.

13 Resident #2 Falls In order to get comfortable this resident would lean forward. This would cause her to fall forward out of her wheelchair. A restraint was placed on her to prevent her from falling out of the wheelchair.

14 Resident #2 In Proper Wheelchair This resident is now in a 16 wide X 20 deep Super Hemi Height wheelchair with a skilcare foot rest and a flat cushion turned sideways to fit the wheelchair seat Notice her arms are positioned on top of the arm rests (not grasping the wheelchair), she is upright, and is supported appropriately

15 Resident #2 This photo gives a view of the K-Special back on the wheelchair allowing her to have a more neutral cervical spine alignment while she looks forward. In this photo you can see she is not weight bearing on one hip any longer.

16 Dump Resident The Seat? # 3 This resident had a click belt alarm on while in the wheelchair. I provided her with an anti thrust cushion and dumped her seat. While on PT she participated in core strengthening and wheelchair mobility training Another intervention was to provide her with a baby doll when she is restless. She focuses on caring and talking to her baby doll and does not attempt to get up.

17 Resident #4 This resident was in a torso restraint I provided him with an anti thrust cushion and dumped his seat along with a slight recline to his seat back of approximately 10 degrees In PT he participated in trunk and BLE extension stretches on the Mat Table and caregiver education on proper positioning and individualized resting schedule

18 Resident #5 As you can see this resident still has a restraint on This is due to family requests. She does attend meals and activities and participates in the Sunshine Room program where the belt is removed while she is monitored by staff. This is all documented in her chart. This resident was provided with a high seat back with lateral wings due to her desire to lean laterally. She also has an activity apron to wear when she is restless as she will reach for the floor and her socks causing her to be a fall risk. The apron is affective in keeping her attention on her lap preventing the forward leaning.

19 This is Resident #5 with the activity apron on. Resident # 5Resifff Resident #5ff #5

20 Resident #6 This resident would present with flexed posture so severe that she would lay her chest on her lap. A click belt restraint was placed on her to avoid a fall. I placed her in a Broda Wheelchair (Item D billable) that has a tilt is space option.

21 This is our get up and go resident. He has a diagnosis of progressed dementia. Resident #7 He was provided with a Rock and Go Wheelchair and a clip alarm The chair is kept in a recline position making sure his feet reach the ground.

22 The Sunshine Room Another intervention we have implemented is the Sunshine Room. This room is for the residents that trigger as frequent falls. It is open from 9 am to 9 pm. At 7 pm the focus is on relaxation in preparation for sleep. It is staffed with non certified staff similar to an activity assistant.

23 The Sunshine Room Continued The staff in the Sunshine Room offer snacks to the residents including ice cream, fluids, and finger foods. This has helped with decreasing weight loss in the building. A binder is kept to track daily participants in the room and fluid and snack intake. This binder is available for surveyors as well. This program has been beneficial in reducing falls. It keeps the residents cognitively engaged with activities they enjoy.

24 DME and Medicare Part B Contact your local DME company and educate them on the ability to bill Medicare Part B for Wheelchairs and Positioning Equipment for your long term residents. The CMS website has information on documentation requirements and HCPCS codes needed for billing. The website is listed as

25 18% 16% 14% 12% 10% 8% 6% 4% National Average 2% 0% Falls Pressure Ulcers Weight Loss

26 To Summarize With creative thinking and interdisciplinary support we can all provide exceptional seating for our residents with out the use of restraints. We all have the power to impact our residents quality of life. As always please feel free to contact me via if you have any further questions and/or need help problem solving. My address is:

27 Thank you