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Seat height is the distance from the floor to the seat of the wheelchair.
It is determined by measuring the distance from the user’s heel to their popliteal fold and adding two inches.

Seat depth is the distance from the front of the seat to the back of the seat.
It is determined by measuring the distance from the user’s posterior buttock to the popliteal fold and subtracting two inches.

Seat width is the distance from one side of the seat to the other.
It is determined by measuring the widest part of the user’s hips and adding two inches.

Back height is the distance from the top of the back portion of the seat to the bottom.
It is determined by measuring the distance between the seat of the chair to the user’s axilla, and subtracting four inches.

Side guard height is the distance between the seat and the top of the armrest.
It is determined by measuring the distance between the seat of the chair and olecranon, and adding one inch.

If a wheelchair is properly fitted, you should be able to:

  • Fit two fingers between the edge of the seat and the user’s popliteal fold.
  • Fit your hands, placed vertically, between the user’s thighs and the armrests/sideguards.
  • Fit four fingers between the top of the seat and the user’s axilla.

The user should obviously look comfortable, be sitting in an upright posture, and be able to operate the wheelchair without areas of excessive pressure or friction. A wheelchair that fits properly will both maximize mobility and ensure proper safety and support.

In addition to properly fitting the wheelchair, it is necessary to educate the user and their family members or caregivers on proper pressure relief techniques and a pressure relief schedule.

  • Anterior, posterior, and lateral weight shifts regularly
  • Position changes every two hours
  • Skin assessment of areas that are typically for pressure ulcers for wheelchair users

Important keys to appropriate user positioning

Long term user positioning must be considered for the prevention of pressure ulcers, as well as contractures.

These vary by what position the user is typically in, but are commonly seen at bony prominences like occipital tuberosity, spine of the scapula, olecranons, sacrum, ischial tuberosities, greater trochanters, and posterior aspect of the calcaneus. Contractures into hip flexion, knee flexion, and plantar flexion are common and patient positioning should be assessed to ensure you are not contributing to their development.

Depending on the needs of the user, they may need to be positioned one way or another, or a position may be contraindicated. Being able to position someone safely and effectively in a variety of ways will reduce the risk of pressure ulcers and contractures.

e sure they understand appropriate positioning and pressure relief techniques. You can’t supervise a patient all day. The patient and the people around them need to know what to do . Establishing the trust and teaching effective education will ensure a user’s safety when you are not there. Position changes are necessary to relieve pressure and prevent an area from getting irritated

Some users may have special considerations you may need to take into account when positioning them. For example, users with transfemoral amputations should not have their residual limb positioned in hip flexion, and users with transtibial amputations should not have their residual limb positioned in knee flexion. Contractures into hip flexion and knee flexion make walking with a prosthetic much more difficult later on.  Wheelchair users with burns need to be splinted in positions of function and special care should be taken on areas that are very seriously burned. If a user has other precautions, such as spinal precautions, sternal precautions, etc, you need to make sure you are adhering to them.

Make a skin check all the time.
It is easier to prevent an issue than to fix it afterwards. It is good idea to get into the habit of assessing a user’’s skin regularly in order to stop a problem before it even starts. If you see something going wrong, assess the situation, make changes, and reassess later.

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