Episode 8 – SCI - Wheelchair Prescription

A physical therapist makes wheelchair recommendations for a patient with a C4 complete spinal cord injury. Which wheelchair feature would be the MOST desirable for this patient?

1.    Removable armrests
2.    Tilt-in-space frame
3.    Handrims with rim projections
4.    Handheld joystick controls

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go! 

A physical therapist makes wheelchair recommendations for a patient with a C4 complete spinal cord injury. Which wheelchair feature would be the MOST desirable for this patient?

1.    Removable armrests
2.    Tilt-in-space frame
3.    Handrims with rim projections
4.    Handheld joystick controls

This question is going to require students to access content knowledge in two specific academic areas C4 Spinal Cord Injury – Clinical Presentation and Wheelchair Features.

C4 SCI – Clinical Presentation

• Paralysis in arms, hands, trunk and legs
• Requires complete assistance with activities of daily living, such as eating, dressing, bathing, and getting in or out of bed
• Requires 24-hour-a-day personal care

If we drill down a little deeper, the patient would have innervation of many of the neck muscles, including the trapezius and levator scapulae. However, they would not have intact innervation to any of the upper extremity muscles.

The second academic area to explore is Wheelchair Features. It’s impossible to reflect on a topic as broad as wheelchair features without narrowing the scope of the review. However, if you were comfortable with the clinical presentation of a patient with a C4 spinal cord injury, it’s possible to reflect on the wheelchair features most essential for this population. 

Remember, it’s always a desirable strategy, when possible, to attempt to generate an answer to the question prior to being exposed to the available options.

Let’s explore each of the wheelchair features listed and reflect on the relative desirability of each option for a patient with a C4 spinal cord injury.

Option 1 - Removable armrests
Removable armrests are a necessary feature for patients that are using a transfer board or for patients who need easier access to the wheels for propulsion.

A patient with a C4 spinal cord injury would not be able to utilize a transfer board or propel their wheelchair manually due to the lack of innervated upper extremity musculature.

Option 2 - Tilt-in-space frame
A tilt-in-space frame allows the patient to change their body orientation in space without changing the angle of the back surface to the seating surface. 

A tilt-in-space frame is necessary for patients that are unable to perform their own weight shifting to reduce the risk for pressure ulcer development (e.g., a patient with a C4 spinal cord injury). Using a tilt-in-space frame, the patient will be able to change their body orientation so that areas of pressure on the body are altered.

Option 3 - Handrims with rim projections
Handrims with rim projections are a necessary wheelchair modification for patients with grip deficits or a hand deformity. The rim projections allow the patient to more effectively grip the handrims so that they can still manually propel the wheelchair. 

A patient with a C4 spinal cord injury has no ability to manually propel a wheelchair, even with rim projections due to the lack of innervated upper extremity musculature.

Handrims with rim projections add depth to the wheel and allow the patient to more easily propel the wheelchair. 

This is indicated with C5 tetraplegia where the lowest innervation includes the biceps, brachialis, brachioradialis, deltoids, rhomboids, and supinator. 

Although a patient with C5 tetraplegia may utilize handrims with rim projections, the necessary energy expenditure may necessitate the use of a power wheelchair for mobility. 

Option 4 - Handheld joystick controls
A handheld joystick control is a wheelchair modification that may be necessary for patients who do not have the requisite upper extremity musculature to manually propel a wheelchair. 

Although this is true of a patient with a C4 spinal cord injury, this patient does not have the upper extremity function to control the joystick. They would instead need a power wheelchair with sip-and-puff controls or a head or chin control.

A handheld joystick control is more often used by a patient with a C5 spinal cord injury. Although a patient at this level of injury may be able to propel a wheelchair with handrims with rim projections, the high energy expenditure makes this unlikely for community mobility. 

The correct answer is Option 2

Let’s explore the all student data:
2% of students selected Option 1, removeable armrests
77% of students selected Option 2, tilt-in-space frame
4% of students selected Option 3, handrims with rim projections
17% of students selected Option 4, handheld joystick controls

System Classification
This question is a Non-Systems question which represents approximately 14% of all exam items.

Content Outline Classification
This question is an Equipment, Devices, and Technologies; Therapeutic Modalities question which represents approximately 6% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Pages 307-309, 696-699 from our review book PTEXAM: The Complete Study Guide.

Bonus Thought
When reviewing completed sample questions, always attempt to reflect on the related subject matter. In this particular case, simply change the level of spinal cord injury and reflect on the clinical presentation and the necessary wheelchair features.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!

Watch the video version of this Q&A episode on YouTube - https://youtu.be/jxdTfW06WLM.