Appropriate wheelchair selection takes time and consideration of many factors. When a medical professional conducts a wheelchair assessment, he/she should incorporate the goals of the client, therapist and caregiver, which sometimes may not be in agreement. To streamline the process, we have put together a 10-item checklist to assist in getting the best-fitting wheelchair for a person's needs, comfort and optimal function.

1. Environment
   What is the environment in which the client will be using the chair - in a nursing facility, at home, outside in the community? What is the layout of the home or facility, and will there be any space constraint issues, such as tight doorways, narrow hallways or high countertops


2. Usage of Chair
   How will the client be using the chair? Is he going to be wheelchair dependent for all mobility? Is she using the chair to complete ADL's (Activities of Daily Living)? How many hours will he be in the chair throughout each day?


3. Clients Physical Features
   A person's height, weight, hip width, femur length and stature will determine the width, depth and height of the wheelchair.


4. Wheelchair Mobility
   Is the client able to propel a manual wheelchair? Can he propel with upper and/or lower extremities? Does she lack strength in her upper body? These factors will also determine the height and weight of the wheelchair. How will he transfer into and out of the chair? What is his range of motion? If the client can not propel, will she qualify for a power wheelchair and what type of controls will she need for safe, independent operation?


5. Cognition & Visual Acuity
   What is the client's capacity for being able to safely operate the chair, see and respond to obstacles in his path and stop as needed.


6. Skin Integrity
   Consider skin breakdown and sensitivity issues. Will the client require special cushions, backrests, leg rests, arm rests, etc?


7. Balance
   Can the client sit upright and unsupported? Lateral supports, backrests, head supports and other options may need to be considered.


8. Posture and Pelvic Positioning
   Wheelchair positioning begins with the pelvis. Is there a pelvic tilt, obliquity or rotation? Note the client's posture. Is there any scoliosis or kyphosis? Also assess hip, trunk, head and neck alignment.


9. Justification
   Assessing the client's needs, as well as wheelchair and accessory design characteristics, there must be medical justification in order to meet insurance guidelines and obtain prior authorization when required.


10. Client-centered Process
    Actively involving the client and caregiver in the process is key to achieving a good outcome in wheelchair selection. Valuable information such as goals, expectations, daily routine, level of activity, maintenance, transportation of the chair and environment can usually be obtained through discussions with the client and caregiver. In the end, the wheelchair must be comfortable for the client or it will never be used.

Fitting a client with the right wheelchair is a complicated and important process. Optimizing that fit is crucial to improving his function and ease of use in his environment. Plus, it will ensure the client's safety and alleviate his health concerns.

By Mary Martin, in conjunction with Melissa Fisher, MSPT, ATP

A common problem for people using wheelchairs, either at home or at skilled nursing facilities is sliding down and possibly out when seated in a wheelchair. Some of the most likely causes of seat slide are the following:

1. Seat depth is too long
2. Seat-to-floor height is too tall resulting in patient sliding out to get feet on the floor
3. Posterior pelvic tilt
4. Lack of lower extremity support
5. Comfort
6. Fatigue

How does one resolve these more typical causes which put wheelchair users at risk of sliding out of wheelchairs? The issues of comfort and positioning can be effectively addressed by conducting an individualized assessment for each wheelchair user. The following are possible solutions to each of the above causes.

1. If the seat depth is too long, you will need to find a different chair with a shorter seat depth. Most standard chairs are meant for transport and do not have adjustable seating. This means locating a different chair with a seat that fits properly for this individual.


2. There are several options for seat-to-floor height issues. You can get a drop seat; lower the current chair, if possible; provide smaller wheels on the wheelchair to make it lower; or locate another chair with lower seat height.


3. For posterior pelvic tilt, you can "dump" the seat (lower rear axle or raise front casters); or you can locate a wedge or anti-thrust cushion.


4. When using leg rests to support lower extremities, prevent sliding, and keep the user's hips/pelvis to the back of the wheelchair, make sure not to over stretch tight hamstrings. This can literally pull the person's pelvis out of the chair. Once hamstring length has been evaluated related to sitting and positioning, then one can adjust foot rests to fit properly.


5. Discomfort in a wheelchair can be the result of any of the above issues. The best approach to address comfort problems is to determine why the wheelchair user is uncomfortable by having a therapist or mobility professional perform a thorough wheelchair assessment. Consider the need for specialty accessories, such as a specialty cushion or back.


6. Sometimes the wheelchair user can just simply be tired. Consult with the person, facility staff and/or other caregivers. Does he need a specific lay down schedule? Have there been changes in meds which are affecting his alertness or cognitive abilities?

By: Mary Martin, in conjunction with Melissa Fisher, MSPT, ATP.

A wheelchair is just a chair on wheels, right? To most people this is the common perception. However, a wheelchair is far more complex in its design and function than given credit. People use them for a variety of daily living reasons, but without question the wheelchair is their legs and their only means of mobility. Due to varying degrees of disability, there are many functions a wheelchair must meet. For most people, the wheelchair is the sole source of mobility and therefore must be up to the task of providing function in many environments. It also must provide proper seating and positioning thus making the chair comfortable and less likely to cause sores on users who are in the chair all day.

Melissa Fisher, MSPT, ATP, explains. “It is important for the wheelchair provider to take a lot of time analyzing and assessing a wheelchair candidate and his/her home so that the proper wheelchair base and accessories are chosen.” Too many disabled individuals are improperly positioned in “out of box” wheelchairs because they didn’t know options existed that would make their chair better suited for their needs. For instance, most people think that manual wheelchairs are propelled by pushing the large wheel in back. But, a very large group of users use their feet to pull the chair forward in conjunction with pushing with their hands. So it is critical that a chair be positioned at the precise height that allows the user’s feet to lie flat on the floor. “If a person is positioned too high off the ground, they can’t propel the chair. They then think that they need a power wheelchair because they can’t use their current wheelchair, when in all actuality they could, but they are in the wrong chair. Speaking from a therapy perspective, we would rather a user stay in a manual wheelchair as long as possible so they keep moving”, says Fisher.

Another aspect of wheelchair use that goes underappreciated is the seating and positioning products that are used on the chair. As people age, their bodies lose bone density and muscles weaken. This combination usually leads to postural problems. A properly fitted wheelchair back and cushion can delay the onset if not entirely remove the risk. “A good wheelchair company always looks at how the user is sitting in the chair”, says Fisher. “We have to assess how long the user will be in the chair throughout the day and what ramifications that can have on their body.”

These are just a few variables that go into determining proper mobility equipment for someone struggling to move safely in their home. Talking to experts in the field of seating and positioning can ensure that you or your loved one gets the right wheelchair for their needs.

By:  Gerald Sloan, CEO, Sloan Medical