Wheelchair Seating Positioning Tips

The pelvis is the key to maintain correct posture as it dictates the position of the head, trunk and extremities for users in wheelchairs.

Good posture is characterised by:

Straight position of head
Physiological curvatures of sagittal plane and straight spine in coronal plane
Well-formed chest
Shoulders slightly backward in relation to pelvis
Symmetrical alignment of pelvis

Modifications to posture and position are best done in small incremental changes as these allow the user to physiologically adapt to them and for the assessor to manage the progress sufficiently.

DISCLAIMER: IN REALITY EVERY OUTCOME HAS TO BE DETERMINED ON THE CLIENT AND BASED ON THE CLINICAL EVALUATION ASSESSMENT.

Clinical Issue	Common suggestions for intervention	Product Choice
Posterior Pelvic Tilt	Decrease thigh to calf angle Drop front of cushion down/build up at rear for sloping seat surface Provide more posterior pelvic support through backrest Create biangular shaping in backrest to accommodate asymmetries Check depth of cushion – may be too deep	Spex Cushion Spex Backrest
Anterior pelvic tilt/Lordosis	Neutral alignment of the pelvis Encourage more weight bearing on ischial tuberosities Position hip belt over ASIS Create a rearward sloping seat and carefully set up the back angle to reduce the tendency to lumbar Lordosis Provide contouring in the backrest to support the users back Using an adapted tray to form an anterior support for the trunk is often very effective and functional for the user	Spex Cushion Spex Backrest
Tight hamstrings	Drop front of cushion down/build up at rear for sloping seat surface Open seat to back angle Decrease thigh to calf angle with footplate position	Spex Cushion
Limited hip flexion (one side or both)	Accommodate fixed limitation in hip flexion by wedging cushion sloping to the front	Spex Cushion
Sliding forward on seat	Provide increased pre-ischial shelf build-up Stabilize pelvis using appropriately angled pelvic belt	Spex Cushion
Extensor Thrust	Increase hip and knee flexion	Spex Cushion
Leg length discrepancy	Leg discrepancy cut-out in cushion	Customised Spex Cushion
Pelvic rotation	Create build-up in pre-ischial support under affected pelvis Contour the back surface to support pelvis if fixed Maximise use of hip belt to control forward side Check dimensions of chair and components. A chair that is too wide, for example, can facilitate pelvic rotation Contoured cushions with good leg troughs Appropriate lower back support is preferable to a canvas back which may mould to the rotated pelvis	Spex Cushion Spex Backrest
Windsweeping	Hip and thigh lateral supports Provide more adductor/abductor support on the cushion with higher contouring/deeper leg troughs	Customised Spex Cushion Spex thigh supports

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Wheelchair Seating Positioning Tips