Wheelchair Patient Positioning Guide for Occupational & Physical Therapists

Studies show that being a wheelchair user is far from the death sentence that many non-users believe it to be. Interviews with wheelchair users frequently result in responses such as, “Just because we are in wheelchairs doesn't mean that we're not happy. Even though we deal with challenging circumstances, we live a very happy and fulfilling life.”

Naturally, having to use a wheelchair—whether from birth or because of a life change later—does bring some negative emotions with it. The main downside of using wheelchairs is not the chair itself but what can happen to the individual confined to it without proper care.

Physical discomfort and pressure sores are two common and severe side effects of sitting in a chair all day. Because the body is not meant to exist in this position for long periods, it is critical to pay careful attention to wheelchair seating and relieve pressure often.

First, you should read a guide on positioning clients in wheelchairs to ensure you understand the requirements for good seating. Next, ensure your clients or loved ones have the best possible fit between their wheelchair and its seat.

We will explore both factors in this post.


Why Does Good Wheelchair Positioning Matter?

Wheelchair positioning matters for client comfort, of course. If a wheelchair user reports they aren’t happy with their seating position, it’s time to help them adjust.

Pressure relief is essential for more than comfort, however. Without adequate movement to take the strain off certain areas for some time, the client is at risk of developing pressure ulcers. A pressure ulcer is an area of skin damaged by repeated rubbing or pressing against a surface. With time, this pressure restricts blood flow, makes skin raw, inhibits moisture wicking, and can become a pressure sore—an open, weeping, painful spot on the body.

These injuries can become serious quickly, and because the client has difficulty sitting in different positions, these sores are hard to treat when they develop. In some cases, especially in individuals with low immunity, they can be life-threatening.

That’s why the question “How should a client be positioned in a wheelchair?” is critical. Let’s look.


Positioning a Client in Their Wheelchair: Step by Step

So, how should a client be positioned in a wheelchair? Follow this simple guide:

Lock the Wheelchair

Ensure the chair is locked on both sides to prevent it from moving during positioning. This step is vital to avoid injury both for you and the client.

Protect Your Back

When positioning someone, always lift with your legs. Squat like you will sit in a chair before reaching forward to move the client.

Check the Buttocks Region

The best way to protect the client’s back and keep them comfortable is to ensure their bottom is to the back of the seat. If it isn’t, lift one leg at a time and push that side backward, then repeat until both buttocks are pressed against the back and the base of the chair.

Check for Evenness

Unless there is a medical reason to do otherwise, you should always ensure that the client’s positioning is even. Their knees should be straight across, their hips at the same level, and their trunk in the center of the chair. This position will reduce areas of higher-than-necessary pressure.

Position the Head

The head should be in the middle of the headrest. Adjust the headrest to support the client’s head where it naturally sits.

Check Feet

Place feet on the footplate, making complete contact with the surface. Adjust the footplate until it is at a natural height for the client. If you’re unsure, check the thighs: they should be parallel to the floor when the client’s feet are firmly planted on the footplate.

Adjust Armrests

Pull armrests up high enough that arms drape naturally onto them. Elbows should rest comfortably at the client’s side at a 90-degree angle. Adjust for activities or when the client’s hands are in their lap.

Tilt the Wheelchair Back if Needed

If the client cannot help much during repositioning, you may need to tilt the wheelchair back. This approach unweights the hips and enables you to move the legs and bottom around.


Assuring the Right Fit: A Necessity for Client Comfort

Understanding client positioning is the first step in keeping wheelchair users happy, comfortable, and free of pressure sores. If the person isn’t using a correctly sized wheelchair, however, it’s hard to keep them in the right spot.

That’s where a wheelchair pressure mapping system comes in. Using sensor-based mats embedded with thousands of pressure points, you can take highly detailed readings of what occurs between client and chair—even in places where a camera or the eye cannot penetrate. The resulting data and image can explain how chairs need adjustment for maximum comfort and health.

Pressure points are distributed across a color range, with blue and green indicating areas of low pressure, yellow medium pressure, and orange and red high pressure. Doctors, nurses, and caregivers can respond more quickly to areas of high pressure by using this map, which operates temporally and spatially, showing movement over time.

The result: happier clients, better-run facilities, more positive health outcomes.


Wheelchair Seating Solutions from XSENSOR

Are you ready to take your wheelchair game to the next level? Get in touch to learn more about the ForeSite SS Wheelchair Seating system. This system gives therapists and clinicians the knowledge and tools they need to make the best possible decisions, adjust chairs, and improve the quality of life for everyone they treat.

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