Maximizing Comfort and Functionality in Wheelchair Seating through Occupational Therapy

• Understanding Wheelchair Seating and Positioning

• Assessment and Evaluation of Seating Needs

• Types and Components of Wheelchair Seating and Positioning

• Final Thoughts

For individuals with mobility impairments, wheelchairs can be a game-changer. They offer a safe and efficient means of getting around and navigating one's environment, making it easier to participate in meaningful activities, also known as "occupations," access community resources, and engage in social activities.

The wheelchair is not just a mobility device; it's a gateway to independence for individuals with limited mobility. Occupational therapists play a vital role in wheelchair selection and training users to confidently navigate their environments. From assessing an individual's needs, to optimizing the wheelchair's features and functionality, occupational therapists empower users to achieve optimal function.

"A wheelchair doesn't define a person's abilities, it simply enhances their opportunities." - Unknown

In this blog post, we'll dive into the importance of proper wheelchair seating and positioning, explore a commonly used assessment called the Mechanical Assessment Tool, and review some critical components of proper seating and positioning, including backrests, footrests, and cushioning.

Understanding Wheelchair Seating and Positioning

Proper seating and positioning are essential for maintaining good posture, preventing pressure sores, and promoting the efficient use of the wheelchair. Let’s look at a few of the specifics:

• Comfort: A comfortable seating position is crucial for users who spend long hours in a wheelchair. By ensuring proper support and pressure distribution, customized cushions and backrests can significantly increase comfort and make daily activities more enjoyable. Adjustments to footrests, armrests, and head supports can accommodate individual preferences and enhance comfort levels.

• Functionality: How a user is positioned in their wheelchair directly affects their ability to perform daily tasks. Proper seating and positioning enable the user to maintain a stable base of support, which is essential for activities such as eating, writing, or using electronic devices. Optimal positioning also allows for more efficient propulsion and maneuverability, ensuring users can navigate their environment independently.

• Health: Inadequate wheelchair seating and positioning can lead to health issues, including:

  • Pressure sores: Uneven weight distribution and prolonged pressure on specific areas of the body can cause skin breakdown. Proper cushioning and regular repositioning can help prevent these painful sores.

  • Spinal deformities: Poor posture can contribute to the development of spinal deformities such as scoliosis or kyphosis. Occupational therapists work to ensure proper spinal alignment and support, minimizing the risk of these complications.

  • Respiratory issues: Slouched or hunched positions can compress the chest cavity, making it difficult for users to take deep breaths. By promoting upright posture, therapists can help improve respiratory function.

  • Circulation problems: Proper positioning and support can promote healthy blood flow to the extremities, reducing the risk of circulatory issues such as deep vein thrombosis or edema.

Occupational Therapy Assessment and Evaluation of Wheelchair Seating Needs

Occupational therapists use a holistic approach during a wheelchair seating assessment because it considers the whole person, not just their physical abilities or limitations. By looking at the person's emotional, social, and environmental factors, therapists can better understand the person’s unique needs, preferences, and lifestyle, ultimately leading to a more personalized and effective intervention. A comprehensive approach recognizes that many factors are interconnected and that it is essential to consider all aspects of a person's life when assessing their wheelchair needs.

Occupational therapists frequently utilize the Mechanical Assessment Tool (MAT) as a component of their seating assessment. The MAT is designed to provide a comprehensive analysis of the client's musculoskeletal system, evaluating the person's posture while seated in their current seating arrangement, as well as in a supine position and while sitting on a firm surface. In addition, clinicians should take note of any neurological issues that could affect posture and muscle length, such as tone and spasm patterns.

During the MAT assessment, the occupational therapist may follow several steps:

1. Client interview: The therapist begins by gathering information about the individual's medical history, daily activities, goals, and concerns related to their wheelchair use. This step helps establish a baseline understanding of the user's needs and preferences.

2. Posture and balance assessment: The therapist then examines the user's posture in various positions (e.g., sitting, lying down) to identify any deviations from proper alignment. They will also assess the user's balance and ability to maintain a stable position in the wheelchair.

3. Range of motion and muscle tone evaluation: The therapist evaluates the individual's range of motion (ROM) and muscle tone in their trunk, pelvis, and extremities. This assessment helps the therapist understand the user's biomechanical capabilities and limitations, informing the selection of appropriate wheelchair features and seating components.

4. Pressure mapping: Pressure mapping technology may be used to assess the user's pressure distribution while seated. This helps the therapist identify areas of high pressure that could lead to pressure sores and informs the selection of cushions and other pressure-relief solutions.

5. Simulation and trial: The therapist may use a simulation chair or a trial wheelchair with adjustable components to identify the best seating configuration for the user. The user will be seated in various configurations to determine the optimal combination of support and comfort.

6. Recommendations and follow-up: The therapist will recommend the most appropriate wheelchair, seating components, and necessary modifications.

(Agency for Clinical Innovation, 2022)

We recommend checking out the following link to learn more about the MAT. It's an excellent resource for healthcare professionals seeking to expand their knowledge of the MAT and its use in wheelchair seating and positioning assessments.

Mechanical Assessment Tool (MAT) by ACI

Types and Components of Wheelchair Seating and Positioning

In this section, we'll take a closer look at the different types of wheelchairs, including standard and tilt-in-space. We’ll examine the individual components of a wheelchair, including the seat, backrest, footrests, armrests, and cushions. We'll briefly explore the function and importance of each component and examine a few different styles. By the end of this section, you'll better understand the various components that make up a wheelchair and how they can be tailored to meet the unique needs of individuals with mobility impairments.

"Your wheelchair is simply a tool that helps you navigate the world. It doesn't define you; it empowers you."

Types of Wheelchairs

There are many different types of wheelchairs, each with its own unique features and functions and including manual, power, transport, bariatric, tilt-in-space and others. Let's briefly examine some of the features of the two most common types found in hospital settings.

Standard Manual Wheelchair:

1. Basic design: A standard manual wheelchair typically features a foldable, lightweight frame with large rear wheels and smaller front casters, making it easier to maneuver and transport. It is designed for users who can self-propel or have a caregiver assist them.

2. Limited positioning options: Standard manual wheelchairs generally have basic backrests and cushions, offering limited positioning options for users. They are more suitable for individuals who have reasonable trunk control and can maintain an upright seated position.

3. Price: Standard manual wheelchairs are usually more affordable than tilt-in-space wheelchairs due to their more straightforward design and fewer features.

4. Best suited for: Users with relatively stable medical conditions, who require essential mobility assistance, and have the ability to transfer in and out of the chair independently or with minimal assistance.

Tilt-In-Space

1. Advanced design: Tilt-in-space wheelchairs feature a mechanism that allows the entire seat and backrest to tilt at an angle while maintaining the user's hip, knee, and ankle angles. This provides better support, pressure relief, and positioning options for users with more complex needs.

2. Enhanced positioning options: The tilt mechanism in these wheelchairs offers better positioning and support for users with limited trunk control or severe muscle tone imbalances. They can help maintain proper alignment and provide additional support for users who may struggle to maintain an upright position in a standard manual wheelchair.

3. Price: Tilt-in-space wheelchairs are generally more expensive than standard manual wheelchairs due to their specialized design and additional features.

4. Best suited for: Users with more complex medical conditions requiring improved pressure management, positioning, and support to maintain optimal posture, prevent complications, and enhance the overall comfort.

Components of Wheelchairs

A wheelchair comprises many components, including frame, wheels, tires, hand rims, brakes, seat, backrest, armrests, footrests, leg rests, caster forks, and anti-tippers, each playing a crucial role in providing mobility, comfort, and support to the user. Each component can be customized to fit the user's unique needs and preferences, including materials, adjustability, and specific positioning requirements.

1. Frame: The frame is the main structural component of the wheelchair, typically made from materials like aluminum, steel, or titanium. It provides the base for all other components and plays a crucial role in the chair's durability, stability, and overall weight.

2. Wheels: Wheelchairs generally have two large rear wheels and two smaller front caster wheels. The rear wheels are used for propulsion, while the front caster wheels allow for easy changes in direction and smooth navigation on various surfaces.

3. Tires: Wheelchair tires can be either pneumatic (air-filled) or solid (made of rubber, foam, or other materials). Pneumatic tires provide a smoother ride and better shock absorption, while solid tires are more durable and require less maintenance.

4. Hand Rims: Hand rims are attached to the rear wheels and enable manual self-propulsion. Users can grip and push them in a circular motion, providing greater independence and mobility.

5. Brakes: Wheelchairs are usually equipped with push-to-lock brakes or attendant-operated brakes. These allow users or caregivers to lock the wheels in place, ensuring stability during transfers and when the chair is stationary.

6. Seat: The seat is a crucial component for user comfort, typically made from fabric, vinyl, or other materials. It can be customized with different seat cushions to accommodate individual pressure relief, positioning, and stability needs.

7. Backrest: The backrest supports the user's back, helping maintain proper posture and prevent spinal deformities. Customizable with various back supports, it ensures proper spinal alignment and pressure distribution.

8. Armrests: Armrests provide support and stability for the user's arms, contributing to overall comfort and balance. They can be height-adjustable, removable, or flip-back to cater to user preferences and facilitate transfers.

9. Footrests: Footrests support the user's feet and help maintain proper leg positioning. They can be adjustable, removable, or swing-away, allowing for easy transfers and individualized positioning requirements.

10. Legrests: Legrests support the user's legs and can be fixed or elevated. Elevating leg rests help adjust the angle of the user's knees and improve circulation, offering additional comfort and support.

11. Caster Forks: The caster forks connect the front caster wheels to the wheelchair frame, enabling the wheels to swivel and maneuver across different terrains, contributing to the chair's overall maneuverability.

12. Anti-Tippers: Anti-tippers are optional safety devices attached to the rear of the wheelchair frame. They prevent the chair from tipping backward on ramps or inclined surfaces, ensuring the user's safety and stability.

Each of these components contributes to the wheelchair's overall functionality, comfort, and safety, enabling users to maintain their independence and participate in daily activities.

Final Thoughts

Wheelchairs play a vital role in promoting independence, participation, and overall quality of life for individuals with mobility impairments. Proper wheelchair seating and positioning are essential for comfort, functionality, and health and occupational therapists play a crucial role in assessing individual needs and recommending the most appropriate wheelchair. By understanding the different types of wheelchairs, their components, and their functions, users and healthcare professionals can work together to select the best wheelchair and seating solutions that cater to individual needs and preferences, ensuring a comfortable and functional mobility experience.

"My advice to other disabled people would be, concentrate on things your disability doesn't prevent you from doing well, and don't regret the things it interferes with. Don't be disabled in spirit as well as physically." - Stephen Hawking

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