DOCSLIB.ORG

Standing up • Full-Time Employee with Permobil to Complications of SCI/D ISS 2016 Ginger Walls, PT, MS, NCS, ATP/SMS Regional Clinical Education Manager Permobil

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Standing up • Full-Time Employee with Permobil to Complications of SCI/D ISS 2016 Ginger Walls, PT, MS, NCS, ATP/SMS Regional Clinical Education Manager Permobil 2/8/2016 Disclosure • Ginger Walls, PT, MS, NCS, ATP/SMS Standing Up • Full-time employee with Permobil to Complications of SCI/D ISS 2016 Ginger Walls, PT, MS, NCS, ATP/SMS Regional Clinical Education Manager Permobil @2015, Permobil, Inc. @2015, Permobil, Inc. Learning Objectives Common Secondary Conditions with SCI Skin breakdown At the conclusion of this activity, the participant will be able to: ↑ obesity & adipose tissue ↑ Cardiovascular disease risk 1. Participants will be able to identify 3 common secondary Are these Bone density complications complications of health conditions associated with SCI/D. Musculoskeletal wear & tear 2. Participants will be able to identify 3 benefits of standing SCI or of Bowel dysmotility chronic sitting? for persons with SCI/D as evidenced by the research. Bladder infections 3. Utilizing the ICF model, participants will be able to discuss Pulmonary Insufficiency 3 evidence-based benefits for body structure/function, Depression functional activities, and/or participation offered by a ↓ function wheelchair-based standing device. ↓ participation @2015, Permobil, Inc. @2015, Permobil, Inc. Accelerated Aging: Interactions Relevant to Aging with SCI Trajectory where the rate and the effects of aging are 1. Current chronologic age accelerated 2. Age at injury Health conditions occur earlier and/or more frequently 3. Duration of injury than would otherwise be observed, leading to a narrow 4. Age cohort –social, economic, and margin of health. medical context around an • Due to physiologic changes due to SCI and impairments that lead to immediate and long term effects on the body individual’s SCI • Susceptibility of those with SCI to numerous medical conditions that – Medical advances impart a health hazard – Access to care and equipment • Disproportionate % of deaths as a result of preventable causes, – ADA 25 year anniversary including septicemia Groah, et al. Am. J. Phys. Med. Rehabil. Vol 91, No 1, Jan 2012 Groah, et al. Am. J. Phys. Med. Rehabil. Vol 91, No 1, Jan 2012 @2015, Permobil, Inc. @2015, Permobil, Inc. 1 2/8/2016 Why Stand? Examining the Evidence Why NOT? Potential Complications of Immobility- After 6 weeks of bed rest •Decreased Bone Mineral Density (BMD) •Risk of Pressure Ulcers •Development of Joint Contractures •Impaired bowel and bladder functioning •Impaired respiratory functioning (Andriaasen, Asbeck, Gastro-Intestinal problems Lindeman, vand der Woude, de • Groot, & Post, 2013) Deitrick J, Whedon G, Shorr E. Effects of immobilization upon various metabolic and physiologic functions of normal men. American Journal of Medicine, 1948; 4: 3. @2015, Permobil, Inc. ©2015, Permobil, Inc. Options for Standing RESNA Position on Wheelchair Standing Devices BWS/Ambulatory Aids • Best comprehensive overall summary of • Bionic Exoskelton research examining wheelchair Separate Standing Devices standers. • Static or Dynamic • Recently updated - 2013 (Current State of Literature) Wheelchair Standing Devices • Manual/Manual • Benefits, Indications, Contraindications, • Manual/Power Case Studies (CP, MS, SCI) • Power/Power • Available online for download www.resna.org @2015, Permobil, Inc. @2015, Permobil, Inc. WHAT IS EVIDENCE BASED PRACTICE? (EBP) Body Structure/Function Issues: Increased Cardiovascular Risk with SCI Increased obesity and adipose tissue Clinical Lack of standing, ambulation, and w/b result in changes in body Experience composition, including decreased muscle mass and increased Needs, values, adipose tissue. Current & preferences • Up to 75% of those with chronic SCI are overweight or obese research of those who • Need for prudent diet, physical activity and equipment are affected considerations. • Increased adiposity in the abdominal region in SCI, positively correlates with increased risk for cardiovascular disease. • Ischemic heart disease and other heart disease were the 3rd and 4th Best leading causes of death in people with SCI. Practices Groah, et al. Am. J. Phys. Med. Rehabil. Vol 91, No 1, Jan 2012 @2015, Permobil, Inc. @2015, Permobil, Inc. 2 2/8/2016 Metabolic effects of sitting STAND FOR HEALTH Study of 123,216 men and women over a 14 year period. Mortality Risk Low High Results were independent of physical activity Activity Levels (METs) level. High activity – Low Activity 13 (Patel, et al., 2010) @2015, Permobil, Inc. @2015, Permobil, Inc. Cardiovascular Output (SCI) 4 subjects with SCI (T6, T5-6, C2-5, C5) completed 12-wk exercise with dynamic weight bearing (DWB) • Surface EMG, HR, BP measured throughout DWB Conclusion: Exercise during DWB can induce positive physiologic and neuromuscular responses and may serve as preparation for more advanced rehabilitation. • Also, improved functional skills due to decreased spasticity Edwards, L., & Layne, C. (2007). Effect of dynamic weight bearing on neuromuscular activation after spinal cord injury. American journal of physical medicine and rehabilitation, 499-506. Why wouldn’t wheelchair users benefit from standing? @2015, Permobil, Inc. @2015, Permobil, Inc. Body Structure/Function Issues: UTI Risk / Hypercalciuria (SCI) Bowel & Bladder 8 men; 2 women (Range: 19-56 y/o); n=10. Incomplete C5-C7 SCI Repeated UTI due to need for • 6 - Early Group (within 6 months post SCI) catheterization. • 5 - Late Group (12-18 months post SCI) • Septicemia is a significant cause of Compared tilt table (at least 20 min) with strengthening exercises death in SCI, compared with general • Both groups – Tilt table had greater impact on Calcium population. balance in urine than strengthening – Early group with more significant results Dysmotility of bowel (Kaplan, Roden, Gilbert, Richards, & Goldschmidt, 1981) @2015, Permobil, Inc. @2015, Permobil, Inc. 3 2/8/2016 Evidence: Standing to Assist with Constipation Survey of Standing Benefits Management (SCI) Dunn et al. (1998): Respondents reported improved bladder emptying, bowel regularity, decreased UTIs, leg spasticity, and less “bed • Single case study - 62 y/o male with T12-L1 ASIA sores”. 78% “highly recommend” the use of the B paraplegia standing device Survey by Eng et al. (2001) perceived benefits • Injured in 1965 - chronic constipation included improved well-being, circulation, skin integrity, bowel/bladder function, digestion, • Standing table 5x/week - 1 hour duration sleep, pain, and fatigue. • Significant increase in frequency of BM’s A survey of 99 individuals with spinal cord injuries also revealed fewer UTIs and improved bowel • Significant decrease in bowel care time regularity attributed to standing (Walter et al., 1999). (Hoenig, Murphy, Galbraith, Zolkewitz, 2001) STANDING – THERE’S NOTHING LIKE IT! @2015, Permobil, Inc. @2015, Permobil, Inc. Body Structure/Function Issues: Evidence about Standing & Respiration (Critical Care) Respiration Patients in ICU who had been intubated and mechanically ventilated more than 5 days (n=15) Pulmonary Insufficiency – • Tilt table to 70 degrees x 5 minutes • Significant improvement in respiratory People with tetraplegia and high parameters during and immediately after tilt table. paraplegia have ineffective • Minute ventilation, tidal volume, respiratory rate, and arterial partial pressure of oxygen and carbon dioxide cough leading to increased • Not present 20 minutes later. mucous retention and infection Chang, A., Boots, R., Hodges, P., Thomas, P., & Paratz, J. (2004). Standing with risk the assistance of a tilt table improves minute ventilation in chronic critically ill patients. Archives of physical medicine and rehabilitation, 1972-1976. @2015, Permobil, Inc. @2015, Permobil, Inc. Orthostatic Hypotension (SCI) Body Structure/Function Issues: Skin Breakdown Survey to determine the impact OH has on restricting the use of standing devices or standing wheelchairs for people with SCI. Skin breakdown is very prevalent in people with SCI both during acute and rehab (n=293) stays, as well as afterwards • 38% suffered from OH In Europe and US, 1 in 4 persons with SCI is affected by PU with the most common • Majority complete injuries; T5 or above (except 1– T12) site being under the ITs 52% were using standing wheelchairs/frames Complications: septicemia, osteomyelitis, renal failure, hinder functional recovery, • 59 people (20% of total), OH limited stander use pain, infection, loss of quality of life Shoham, N; Levy, A; Kopplin, K; Geffen, A. “Contoured • 16 people (5.5% of total) not standing due to fear of worsening Costly: Managing full thickness PU in US Foam Cushions Cannot Provide Long-term Protection can cost up to $70,000 Against Pressure Ulcers for Individuals with SCI: OH Annual PU costs in US estimated to be $11 Modeling Studies”. Advances in Skin and Wound Care. billion July 2015, p 303-316. Chelvarajah, R. (2009). Orthostatic hypotension following spinal cord injury: Impact of the use PREVENTION IS KEY www.woundcarejournal.com of standing apparatus. NeuroRehabilitation, 237-242. @2015, Permobil, Inc. @2015, Permobil, Inc. 4 2/8/2016 Superficial Deep Sustained Cellular Deformation with Chronic Sitting Sustained compression can cause cell deformation, leading to tissue breakdown Extrinsic Stekelenburg in 2007 concluded: Extrinsic Risks • Pressure • “2 hours of compressive loading lead to irreversible damage; Risks whereas, ischemic loading results in reversible tissue changes” • Shear • Friction • “Large deformation, in conjunction with ischemia, provides the • Posture • Temperature main trigger for irreversible muscle damage.” • Stiffness of • Moisture support (Ryan, 1990, Bouten, 2003, Stekelenburg, 2007) • Time
Load more

Recommended publications
  • Guidelines for Use of Durable Medical Equipment for Persons with Spinal Cord Injury & Dysfunction
    Guidelines for Use of Durable Medical Equipment For Persons with Spinal Cord Injury & Dysfunction 2010 Guidelines for Use of Durable Medical Equipment For Persons with Spinal Cord Injury & Dysfunction Acknowledgements We thank those who gave time and effort to this project for sharing their expertise willingly to enhance the lives of those with spinal cord injury or dysfunction. Contributing Authors: (alphabetical order) Karyn Baig, PT, DPT Alexis Kahn, MS, OTR/L Staff Physical Therapist Shriners Hospital for Children 1199 Pleasant Valley Way 3551 North Broad Street Kessler Institute for Rehabilitation Philadelphia, PA 19140 West Orange, NJ 07052 Isa McClure, MAPT * Katherine Burkett, MS, OTR/L Clinical Specialist, Physical Therapy Staff Occupational Therapist Kessler Institute for Rehabilitation Shriners Hospital for Children 1199 Pleasant Valley Way 3551 North Broad Street West Orange, NJ 07052 Philadelphia, PA 19140 M.J. Mulcahey, PhD, OTR/L * Christina Calhoun, MSPT Director of Rehabilitation & Clinical Research Clinical Research Specialist/Physical Therapist Shriners Hospitals for Children Shriners Hospital for Children 3551 N.Broad Street, 8th Floor 3551 North Broad Street Philadelphia, PA 19140 Philadelphia, PA 19140 Cynthia Nead, COTA/L Kathleen L. Dunn, MS, RN, CRRN, CNS- Senior COTA BC Occupational Therapy Clinical Nurse Specialist & Rehabilitation Case Kessler Institute for Rehabilitation Manager 1199 Pleasant Valley Way Spinal Cord Injury Center (128) West Orange, NJ 07052 VA San Diego Healthcare System 3350 La Jolla Village Dr. San Diego, CA 92161 Richard Nead, BAEd, CRDS Clinic Manager Jill Garcia, MS, OTR/L, ATP Kessler Institute for Rehabilitation 1199 Pleasant Valley Way Senior Occupational Therapist Kessler Institute for Rehabilitation West Orange, NJ 07052 1199 Pleasant Valley Way West Orange, NJ 07052 Laure Rutter, RN, BSN SCI Program Coordinator Amanda Horley, MOT, OTR/L Shriners Hospital for Children Shriner’ Hospital for Children 3551 North Broad Street 3551 North Broad Street Philadelphia, Pa.
    [Show full text]
  • A Systematic Review of Supported Standing Programs
    Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach 3 (2010) 197–213 197 DOI 10.3233/PRM-2010-0129 IOS Press Review Article A systematic review of supported standing programs Leslie B. Glickman∗, Paula R. Geigle and Ginny S. Paleg1 University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, Baltimore, MD, USA Accepted 1 February 2010 Abstract. Objective: The routine clinical use of supported standing in hospitals, schools and homes currently exists. Questions arise as to the nature of the evidence used to justify this practice. This systematic review investigated the available evidence underlying supported standing use based on the Center for Evidence-Based Medicine (CEBM) Levels of Evidence framework. Design: The database search included MEDLINE, CINAHL, GoogleScholar, HighWire Press, PEDro, Cochrane Library databas- es, and APTAs Hooked on Evidence from January 1980 to October 2009 for studies that included supported standing devices for individuals of all ages, with a neuromuscular diagnosis. We identified 112 unique studies from which 39 met the inclusion criteria, 29 with adult and 10 with pediatric participants. In each group of studies were user and therapist survey responses in addition to results of clinical interventions. Results: The results are organized and reported by The International Classification of Function (ICF) framework in the following categories: b4: Functions of the cardiovascular, haematological, immunological, and respiratory systems; b5: Functions of the digestive, metabolic, and endocrine systems; b7: Neuromusculoskeletal and movement related functions; Combination of d4: Mobility, d8: Major life areas and Other activity and participation. The peer review journal studies mainly explored using supported standers for improving bone mineral density (BMD), cardiopulmonary function, muscle strength/function, and range of motion (ROM).
    [Show full text]
  • RESNA Position on the Application of Wheelchair Standing Devices RESNA Position on the Application of Wheelchair Standing Devices
    RESNA Position on the Application of Wheelchair Standing Devices Rehabilitation Engineering & Assistive Technology Society of North America 1700 N. Moore Street, Suite 1540 Arlington, VA 22209 Phone: 703-524-6686 Fax: 703-524-6630 Approved by RESNA Board of Directors March 2007 RESNA Position on the Application of Wheelchair Standing Devices RESNA Position on the Application of Wheelchair Standing Devices Clinical experience suggests that wheelchair users often experience painful, problematic and costly secondary complications due to long term sitting. Standing is an effective way to counterbalance many of the negative effects of constant sitting 1,2. Standers integrated into wheelchair bases enhance the beneficial effects of standing since they allow for more frequent, random and independent performance of standing than in persons who use standing devices outside of a wheelchair base. Integration of this feature into the wheelchair base also enables standing to enhance functional activities. It is RESNA’s position that wheelchair standing devices are often medically necessary, as they enable certain individuals to: Improve functional reach to enable participation in ADLs (Activities of Daily Living (i.e. grooming, cooking, reaching medication) Enhance independence and productivity Maintain vital organ capacity Reduce the occurrence of Urinary Tract Infections Maintain bone mineral density Improve circulation Improve passive range of motion Reduce abnormal muscle tone and spasticity Reduce the occurrence of pressure sores Reduce the occurrence of skeletal deformities, and Enhance psychological well being. Special precautions must be exercised when utilizing standers, in order to avoid the risk of injury, such as fractures. A licensed medical professional (i.e. physical or occupational therapist) must be involved with the assessment, prescription, trials and training in the use of the equipment.
    [Show full text]
  • Standing Systems
    MEDICAL POLICY STANDING SYSTEMS Policy Number: 2014T0210N Effective Date: August 1, 2014 Table of Contents Page Related Policies: DME, Orthotics, Ostomy BENEFIT CONSIDERATIONS………………………… 1 Supplies, Medical Supplies, COVERAGE RATIONALE……………………………… 2 and Repairs/Replacement APPLICABLE CODES………………………………….. 2 DESCRIPTION OF SERVICES................................. 2 CLINICAL EVIDENCE………………………………….. 3 U.S. FOOD AND DRUG ADMINISTRATION………… 5 CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS)………………………………………. 5 REFERENCES………………………………………….. 5 POLICY HISTORY/REVISION INFORMATION…….. 6 Policy History Revision Information INSTRUCTIONS FOR USE This Medical Policy provides assistance in interpreting UnitedHealthcare benefit plans. When deciding coverage, the enrollee specific document must be referenced. The terms of an enrollee's document (e.g., Certificate of Coverage (COC) or Summary Plan Description (SPD) and Medicaid State Contracts) may differ greatly from the standard benefit plans upon which this Medical Policy is based. In the event of a conflict, the enrollee's specific benefit document supersedes this Medical Policy. All reviewers must first identify enrollee eligibility, any federal or state regulatory requirements and the enrollee specific plan benefit coverage prior to use of this Medical Policy. Other Policies and Coverage Determination Guidelines may apply. UnitedHealthcare reserves the right, in its sole discretion, to modify its Policies and Guidelines as necessary. This Medical Policy is provided for informational purposes. It does not constitute medical advice. UnitedHealthcare may also use tools developed by third parties, such as the MCG™ Care Guidelines, to assist us in administering health benefits. The MCG™ Care Guidelines are intended to be used in connection with the independent professional medical judgment of a qualified health care provider and do not constitute the practice of medicine or medical advice.
    [Show full text]
  • (SPIRES): a Functional Standing Frame Programme
    Logan et al. Pilot and Feasibility Studies (2018) 4:66 https://doi.org/10.1186/s40814-018-0254-z STUDY PROTOCOL Open Access Standing Practice In Rehabilitation Early after Stroke (SPIRES): a functional standing frame programme (prolonged standing and repeated sit to stand) to improve function and quality of life and reduce neuromuscular impairment in people with severe sub-acute stroke—a protocol for a feasibility randomised controlled trial Angie Logan1* , Jennifer Freeman1, Bridie Kent2, Jillian Pooler3, Siobhan Creanor4,5, Jane Vickery4, Doyo Enki5, Andrew Barton6 and Jonathan Marsden1 Abstract Background: The most common physical deficit caused by a stroke is muscle weakness which limits a person’s mobility. Mobility encompasses activities necessary for daily functioning: getting in and out bed, on/off toilet, sitting, standing and walking. These activities are significantly affected in people with severe stroke who typically spend most of their time in bed or a chair and are immobile. Immobility is primarily caused by neurological damage but exacerbated by secondary changes in musculoskeletal and cardiorespiratory systems. These secondary changes can theoretically be prevented or minimised by early mobilisation, in this case standing up early post-stroke. Standing up early post-stroke has been identified as an important priority for people who have suffered a severe stroke. However, trials of prolonged passive standing have not demonstrated any functional improvements. Conversely, task- specific training such as repeated sit-to-stand has demonstrated positive functional benefits. This feasibility trial combines prolonged standing and task-specific strength training with the aim of determining whether this novel combination of physiotherapy interventions is feasible for people with severe stroke as well as the overall feasibility of delivering the trial.
    [Show full text]
  • Standing Wheelchair
    Standing Wheelchair Bianca Bisa, Chieh Yu, Hsin-Fu Chen Steinhardt Occupational Therapy What is “Standing Wheelchair”? ● a.k.a ”Standing Chair“ ● assistive technology similar to standing frame ● allows wheelchair user to raise the chair from seated to standing position ● supports the person in standing position ● enables interaction with people and objects at eye level ● Help people increase quality of life in PHYSICAL and SOCIAL areas. ● Decrease possibility of secondary diseases. (i.e. Pressure sore and Urinary tract infections) Why “Standing Wheelchair”? Why don’t we choose traditional wheelchair instead? Potential Disadvantages of traditional wheelchair: ● Quality of Life (QoL) ● Secondary diseases (i.e. pressure sore, UTI) ● Limits in social activities and some kinds of sport activities ● Psychosocial problems Diagnosis and users People with mild to severe physical disabilities: 1) Spinal cord injury 2) Traumatic brain injury 3) Cerebral palsy 4) Muscular dystrophy 5) Multiple sclerosis 6) Stroke 7) Spina Bifida 8) Rett Syndrome 9) Post-polio syndrome Types of Standing Wheelchair 1. Manual operation 2. Power-operated wheels with manual lifting mechanism 3. Fully power-operated Benefits ● Health Benefits ● Lifestyle Benefits Health Benefits ● Improve circulation ● Reduce skin breakdown ● Improve respiratory capacity ● Reduce urinary tract infections (UTI's) ● Strengthen long bones ● Reduce spasticity ● Improve bowel function Lifestyle BENEFITS ● Improve independence among users ● Increase self-esteem ● Increase social-interaction ● Enjoy greater opportunities for employment ● Improve overall quality of life (QoL) http://thestandingcompany.com/pressure-sores/2866386 Contraindications of Standing Wheelchair ● Existing contractures ● sitting for a very long time(X-rays,bone density) ● Bone Mineral Density(BMD), osteoporosis ● postural hypotension ● sacral shearing Motivation Motivation is an very important component in occupational therapy.
    [Show full text]
  • Systematic Review and Clinical Recommendations for Dosage Of
    Paleg and Livingstone BMC Musculoskeletal Disorders (2015) 16:358 DOI 10.1186/s12891-015-0813-x RESEARCH ARTICLE Open Access Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions Ginny Paleg1* and Roslyn Livingstone2 Abstract Background: Sitting for more than 8 h a day has been shown to negatively impact health and mortality while standing is the recommended healthier alternative. Home-based standing programs are commonly recommended for adults who cannot stand and/or walk independently. The aim of this systematic review is to review effectiveness of home-based standing programs for adults with neurological conditions including stroke and spinal cord injury; and to provide dosage guidelines to address body structure and function, activity and participation outcomes. Methods: Eight electronic databases were searched, including Cochrane Library databases, MEDLINE, CINAHL and EMBASE. From 376 articles, 36 studies addressing impact of a standing intervention on adults with sub-acute or chronic neurological conditions and published between 1980 and September 2015 were included. Two reviewers independently screened titles, reviewed abstracts, evaluated full-text articles and rated quality and strength of evidence. Evidence level was rated using Oxford Centre for Evidence Based Medicine Levels and quality evaluated using a domain-based risk-of-bias rating. Outcomes were divided according to ICF components, diagnoses and dosage amounts from individual studies. GRADE and the Evidence-Alert Traffic-Lighting system were used to determine strength of recommendation and adjusted in accordance with risk-of-bias rating. Results: Stronger evidence supports the impact of home-based supported standing programs on range of motion and activity, primarily for individuals with stroke or spinal cord injury while mixed evidence supports impact on bone mineral density.
    [Show full text]
  • Scope Annual Report 2015-2016 1 Scope’S Divisions Services Provided to People with a Disability
    Annual Report 2015-2016 Vision statement Contents Scope will inspire and lead change Scope’s divisions and services 2 to deliver best practice. We will: Scope 2015-16 Highlights 4 • Support and listen to each person and their family. Five year scorecard 6 • Provide leadership to influence strategy President’s Report 8 and policy. CEO’s Report 9 • Deliver person driven, flexible and responsive services to build a sustainable future. Financial Highlights 10 • Build on our foundation for success Reporting against our Strategic Plan 12 through our expertise in service delivery, workforce development, Customer driven 14 quality improvement and research. Grow by delivering customer driven We will deliver better outcomes. supports that people with a disability value and choose. About Scope Engaged and productive 18 Cultivating a growing, productive and values driven workforce. • Scope is a disability service provider. Our services support the needs of people High performing 22 with physical, intellectual and multiple Build a high performing, innovative disabilities, and their families. and financially viable organisation. • Scope provides services from 99 service locations and employs 1527 people, Mission based 28 including supported employees. Build community capacity to recognise the human rights and citizenship of Scope’s total revenue was $92.2 million • people with disabilities. in 2015-2016. • Scope has a membership base of 485. Our People 32 ABN 63 004 280 871 Organisational chart 38 Scope’s 2016 Annual General Meeting will be Executive Leadership team in profile 40 held on November 16th, 2016. Board in profile 42 Annual Report Corporate Governance Statement 44 Scope’s representation in publications objectives and conferences 46 Scope’s mission is to Thank you 47 This document reports on Scope’s activities, enable each person achievements and financial performance Support Scope 51 during 2015-2016.
    [Show full text]
  • Guidelines for the Prescription of a Seated Wheelchair Supplement 1
    Guidelines for the prescription of a seated wheelchair Supplement 1: Wheelchair features - Standing wheelchair You may copy, distribute, display and otherwise freely deal with this work for any purpose, provided that you attribute the LTCSA and EnableNSW as the owners. However, you must obtain permission if you wish to (1) charge others for access to the work (other than at cost), (2) include the work in advertising or a product for sale, or (3) modify the work. ISBN: 978-1-921422-22-5 For further copies Contact: Lifetime Care and Support Authority on [email protected] Or download from http://www.lifetimecare.nsw.gov.au/Resources.aspx © Lifetime Care and Support Authority (LTCSA) Suggested citation: Lifetime Care and Support Authority, Guidelines on wheelchair prescription. Supplement 1: Wheelchair features – Standing wheelchair. LTCSA editor, 2012, Sydney. Author: Sue Lukersmith – Advisor (Evidence based guidance) Guidelines for the prescription of a seated wheelchair Page | 2 Supplement 1: Wheelchair features – Standing wheelchair Table of Contents Table of Contents .......................................................................................................................3 Introduction ...............................................................................................................................4 Definition....................................................................................................................................5 The Therapist’s approach ...........................................................................................................5
    [Show full text]
  • Clinical Guideline for Standing Adults Following Spinal Cord Injury
    CLINICAL GUIDELINE FOR STANDING ADULTS FOLLOWING SPINAL CORD INJURY Spinal Cord Injury Centre Physiotherapy Lead Clinicians United Kingdom and Ireland Table of Contents 1 Introduction 2 2 Target users 2 3 Aims 2 4 Objectives 2 5 Scope of the guideline 3 6 Development strategy 3 7 Searching for the evidence 4 8 Dissemination 6 9 Implementation 6 10 Revision 7 11 Outcome measures 7 12 Health benefits, side effects and risks 7 13 Financial implications 7 14 Audit 7 Clinical Guideline for standing adults following spinal cord injury 8 15 Benefits 8 16 Precautions 10 17 Risk assessment 11 18 Recommendations 11 19 Further research 13 20 Conclusion 13 Acknowledgments 14 Appendix 1 The ScHARR Hierarchy 15 Appendix 2 Grading of recommendations (after NICE 2001) 16 Appendix 3 Data extraction framework 17 References 31 1 Clinical Guideline for Standing Following SCI Spinal Cord Injury Centre Physiotherapy Lead Clinicians April 2013 Development of Clinical Guideline for Standing Adults following Spinal Cord Injury 1. Introduction The Guideline for Standing adults following Spinal Cord Injury (GSASCI) was developed by the Spinal Cord Injury Centre Physiotherapy Lead Clinicians. Physiotherapists have a duty to base their practice on the best available evidence (Chartered Society of Physiotherapy [CSP] 2002). The guideline draws on available evidence and expert opinion with the purpose of providing a plain, practical and justified recommendation for standing following Spinal Cord Injury (SCI). The GSASCI covers the practice of standing patients as part of rehabilitation and as part of a maintenance programme following discharge from the acute setting. This guideline addresses the clinical question: ► What is the best practice in standing adults with spinal cord injury? 2.
    [Show full text]
  • Guidelines to Promote the Inclusion of Pupils with Physical Difficulties in Mainstream Schools
    Guidelines to Promote the Inclusion of Pupils with Physical Difficulties in Mainstream Schools Department for Children and Young People DOCUMENT REFERENCE COVER SHEET Section 1 Document Purpose: (E.g. For Information information, for guidance etc Guidelines to promote the inclusion of pupils with Document Title: physical disabilities in mainstream schools. Author: Inclusion Support Number of Pages: 78 Publication Date: August 2005 Target Audience: General Public Also Sent To: Further Copies from: Eryl Daniels Further Information from: Price: D410-1-268-08 Document Reference: Keywords: These guidelines have been prepared to support Summary: schools in developing their capacity to remove barriers to learning experienced by some children and young people with physical difficulties. Replaces/Updates/Relates To: 2008 Criteria Section 2 For CYPIS use only Copyright: Internet/Intranet Address: www.southglos.gov.uk Controlled Vocabulary Terms This information can be made available in other languages, in large print, braille or on audio tape. Please phone 01454 868008 if you need any of these or any other help to access Council services. Authors Annie Broziatis Deputy Head Paediatric Occupational Therapy, North Bristol Health Trust Jenny Dicker Senior Occupational Therapist Health and Disability Team, Department of Children & Young People (DCYP) Jo Chambers Teacher in charge of Resource Base for Children with Visual Impairment and or Physical Difficulties, Emersons Green Primary School Eryl Daniels SEN Support Network Manager, DCYP Sue Fairhurst Senior Educational Psychologist, DCYP Jane Hall Inclusion Support, Co-ordinator, DCYP Jane Lund Early Years Inclusion Manager, DCYP Pat Moore Inclusion Support Co-ordinator, DCYP Acknowledgments We would like to thank colleagues from the Department for Children and Young People, Health and Schools for their support with the preparation of these guidelines.
    [Show full text]
  • Spasticity and Bone Density After a Spinal Cord Injury
    J Rehabil Med 2009; 41: 1080–1084 ORIGINAL REPORT SPASTICITY AND BONE DENSITY AFTER A SPINAL CORD INJURY Inka Löfvenmark, RPT, MSc1, Lars Werhagen, MD, PhD1,2 and Cecilia Norrbrink, RPT, PhD2 From the 1Spinalis SCI Unit, Karolinska University Hospital and 2Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden Study design: Descriptive, cross-sectional study. to immobilization or disuse and to increased bone resorption Objective: To assess the relationship between spasticity and post-injury. The level of non-loading of the skeleton is related bone mineral density in the lower extremities in individuals to the degree of demineralization, and therefore it is mainly with a motor complete spinal cord injury. below the neurological level of injury that demineralization Methods: Eighteen individuals, matched for time since injury, will occur (1, 2, 4, 6). There are multiple causes that can af- gender, and age, were included in the study. Nine men had fect bone density; age, gender, menopause, heredity, ethnicity, severe spasticity, and 9 men had spasticity that was either body height and weight, physical activity, corticosteroid use, mild or not present. Comparisons regarding bone mineral calcium intake, smoking, and alcohol (9, 10). density were made using dual energy X-ray absorptiometry. Some authors have discussed whether bone loss in Regions of interest measured were total leg, pelvis, femoral wheelchair-users can be prevented through activities such as neck and total hip. Between-group differences regarding fat weight-bearing through passive standing in a standing frame/ and lean tissue were analysed. tilt board, passive bicycling, or other activities. Two studies Results: Background data, such as weight, height, standing (11, 12) showed that early interventions with passive weight- and exercising habits, smoking and alcohol use, were similar in both groups.
    [Show full text]