An Occupational Therapist’s Role in Wheelchair Seating and Positioning

Occupational therapists responsible for helping people in wheelchairs live their best lives have a heavy burden. It would help if you made your patients as comfortable and safe as possible, all while confined to a space only slightly larger than the average dining room chair. Plus, you must assume they cannot move much on their own, or if they can, the distance they can adjust will be limited.

It’s no wonder problems such as spinal misalignment, and pressure sores are so rampant among people who use wheelchairs. The challenges are high, and the array of tools available to help the clinician create optimal outcomes has continued to become more robust to help prevent these problems in the long term.

Happily, they do exist. Today’s hospitals and clinics see thousands of people every year who are forced to use wheelchairs, so it is time to put these tools into widespread use. If you have wondered how to make wheelchair assessments more accurate, training more efficient, fittings more adept, and people more comfortable, keep reading.

What Is Wheelchair Seating?

Before we discuss wheelchair interventions for your patients, it is essential to look at the basics: just what is wheelchair seating? The answer might sound obvious, but it is worth considering because poor seating can result in elevated body pressures, tissue damage, sores, infections, and even shortened lifespans.

Wheelchair seating encapsulates a broad array of factors, including:

• The person’s spinal positioning;
• The placement of their feet and alignment of their legs;
• Positioning of the head;
• Armrest placement;
• Cushions and padding meant to distribute pressure and constrain movement; and
• Potential adjustments the person can make on their own.

Good wheelchair seating will consider all of this, but it also accounts for the exact angles at which each joint must exist for optimum comfort and health. (For example, the knees must be at or below the level of the hips, while the pelvis must be at a tilt between 0 and 15 degrees in most cases—a great deal for the clinician to keep in mind when dealing with disability or injury.)

The good news is, with the correct settings and cushioning, the wheelchair user will have the tools at their disposal to relieve pressure frequently (or to have their caregiver do it), if they or their caregiver have been taught proper positioning.

What Is Wheelchair Positioning?

Wheelchair seating and wheelchair positioning are closely related. While seating describes how the person should sit, positioning describes how the person is put in the chair to achieve the correct posture.

Wheelchair patient positioning is simple once you have done it enough times, but you must consider all areas of the body when creating a complete plan. Otherwise, your strategy may have holes in it that allow postural discomfort or elevated pressure. These areas include:

Bottom

Most obviously, the person will rest most of their weight on their seat. With proper padding and stability (and assuming no preventative issues), a wheelchair user can still move their chair, make adjustments, perform daily activities, and even play sports. Good padding will prevent skin breakdown and other long-term problems.

Proper seating means that the user’s bottom is to the back of the chair. They should not feel cramped, but they should feel secure. The spine should be straight, and where other issues do not prevent it, the pelvis should be horizontally level.

Legs and Feet

Thighs should have space between them, be level with the floor, and bend at the knee at a roughly 90-degree angle. Feet should rest comfortably on the footrests, with the entire sole of the foot making contact.

It can sometimes be hard to tell whether a patient is properly positioned in the leg area. Even if the thighs look properly aligned, the underside of the thighs can sometimes build up pressure, which is where a pressure-sensitive wheelchair placement system comes in. We will get to that in a moment.

Arms

Some patients will not need arm support. If they cannot do much activity on their own, or if it is more comfortable to hold their arms in their lap, or both, then you may not need to worry much about the armrests.

However, most patients need some form of arm support, so arms must also be properly aligned. Without that, you could leave them at an uncomfortable angle that could create joint issues, cause pressure to build up, or hamper mobility. Ensure arms are at the right height so the patient’s hands can rest comfortably in the lap when not using them.

XSENSOR: A Full Wheelchair Seating and Positioning Solution

Clinicians want to reduce pressure ulcers and other injuries, aid in seat cushion evaluation and selection, educate and train patients and caregivers, and offer personalized care and treatment for each individual.

You must also train your staff in the proper use of wheelchair positioning protocols so that everyone knows how to follow the steps that will lead to the healthiest patient outcomes.

To achieve these outcomes, you need the right sensor technology, capable of measuring pressure across the entire wheelchair seating area so you can make the proper adjustments and use the correct cushions and padding. That technology must be:

• Highly accurate without the need for recalibration;
• Equipped with tools to evaluate symmetry and make note of anatomical features;
• Provide high image quality so you do not miss any details;
• Use wireless, undetectable sensors that will not get in the way; and
• Come equipped with both software and hardware to minimize setup and hit the ground running.

If you’re tired of systems that are outdated, inaccurate, hard to use, in constant need of recalibration or lack depth, the ForeSite® SS is here. Say goodbye to confusion and hello to precise wheelchair seating measurements, AI-powered analysis, and optimized performance at your clinic, each and every day.

XSENSOR’s medically certified, tablet-friend, HIPAA-compliant systems are both easy to use and rich in detail. With minimal training and maximum intel, you can look forward to a new workflow today.