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Permobil Blog / July 20, 2017

Incorrect Seat Dimensions: Could this be the true culprit of poor posture in the wheelchair?

Part 9 in our LTC Seating & Positioning series intended to shed some light on the mystery of seating and positioning in the LTC setting. See Part 1, Part 2, Part 3, Part 4, Part 5, Part 6Part 7, and Part 8. Looking for more information on seating and positioning? Check out our digital, rehab-focused Wheelchair Seating & Positioning Guide here.  


 

Seating and positioning can be frustrating enough, but dealing with a very involved resident with multiple medical complications and postural deformities presents an even larger challenge. Often, when dealing with a seating issue, we first consider what is “wrong” with the resident’s posture. Our minds jump to what piece of equipment we could purchase to accommodate their postural abnormality. We automatically try to correct the posterior pelvic tilt, anterior pelvic tilt, pelvic obliquity, rotation of the pelvis, or the windswept posture. However, we need to take a step back and consider that the real issue might be the “vehicle” we are placing this resident in. Have we considered that the true culprit of poor wheelchair positioning may be the wheelchair itself?!

I understand firsthand that in the nursing home setting we are often required to use stock wheelchairs from the storage rooms. However, we NEED to understand the importance of a properly fitted wheelchair in positioning a resident well, which, in turn, prevents the unwanted movement that precedes falls, wounds, and injury. In this blog, we are going to focus on seat dimension and look at how an ill-fitting seat surface can be the cause of the abnormal postures we are trying to accommodate. Many times, if we can correct the issues with the wheelchair itself, the poor posture can miraculously disappear!

The charts below break down specific issues your resident could be having in relation to incorrect wheelchair seat width and depth. These two dimensions are crucial to proper pelvic and LE alignment.

HAMMOCKING SEAT SLING
What is going on? Negative Result What can you do?
Pelvis collapses Posterior pelvic tilt aka sacral sitting Add Rigid Insert
Resident seeks out one side of wheelchair for stability Pelvic obliquity Add Rigid Insert 
Resident compensates by rotating pelvis for stability Pevlic rotation Add Rigid Insert
LEs "sweep" to one side Windswept posture of LEs Add Rigid Insert

 

WIDTH: TOO NARROW
 What is going on? Negative Result What can you do?
Excess pressure at trochanter from contact with the chair Wound risk at the trochanter

Measure hip width

Look for a skin protection cushion that immerses the trochanters

Resident rotates hips to "fit" into the chair Pelvic rotation Measure hip width
Resident "sweeps" LEs to one side, trying to avoid buildup of pressure on the trochanters Windswept posture of the LEs

Measure hip width 

Find a cushion with medial abduction and lateral adduction contours to maintain LE alignment

  

WIDTH: TOO WIDE
 What is going on? Negative Result What can you do?
Resident leans to one side to increase stability. Pelvis will be lower on that side Pelvic obliquity Measure hip width
Pelvis collapses Posterior pelvic tilt aka sacral seating Measure hip width
Pelvic collapse causes hips to internally rotate and LEs to excessively adduct

Strain & contracture risk at hip joints

Wound risk at medial knees where knees rub together

Find a cushion with medial abduction and lateral adduction contours to maintain LE alignment
 LEs "sweep" to one side when LE weakness is present Windswept posture of LEs

Measure hip width

Find a cushion with medial abduction and lateral adduction contours to maintain LE alignment

 

DEPTH: TOO DEEP
 What is going on? Negative Result What can you do?

Seat sling digs into the back of legs causing pain

Resident will slide forward to alleviate the pain

Posterior pelvic tilt aka sacral sitting Measure upper leg length minus 2"

Seat sling digs into the back of legs decreasing circulation, increasing LE edema

Resident slides forward to alleviate numbness

Posterior pelvic tilt aka sacral sitting Measure upper leg length minus 2"
Foot propulsion more difficult, resident slides forward for better heel strike

Posterior pelvic tilt aka sacral sitting

Measure upper leg length minus 2"
Resident will slide forward immediately after repositioning Posterior pelvic tilt aka sacral sitting

Measure upper leg length minus 2"

 *Use a manual wheelchair that has seat depth adjustability: K0004

DEPTH: TOO SHALLOW
 What is going on? Negative Result What can you do?

Decreased femoral contact and LE support

Windswept posture, abduction, or adduction of LEs

Measure upper leg length minus 2"

Find a cushion with medial abduction and lateral adduction contours to maintain LE alignment

Reduced area for pressure redistribution results in increased pressure at the ITs, sacrum, and coccyx

Wound risk at ITs, sacrum, and coccyx

Measure upper leg length minus 2"

Look for a skin protection cushion that immerses and/or offloads the bony prominences

Pelvis collapses inward due to lack of LE support to ensure pelvic alignment

Strain & contracture risk at hip joints

Wound risk at medial knees where knees rub together

Measure upper leg length minus 2"

Find a cushion with medial abduction and lateral adduction contours to maintain LE alignment

*When LE alignment is an issue: think CONTOURS when choosing a cushion!

Seating-Contours.jpg


 

Multiple wheelchair factors effect posture and should be considered when seating a resident. Don’t forget to consider:

  • Wheelchair seat width and depth
  • Seat sling tension and position

Understanding how seat dimensions as well as hammocking seat slings effect postural alignment and utilizing the suggested methods to deal with each, will allow you to look at those storage closet chairs and make a better choice as to which size is needed. ALWAYS take accurate measurements of your resident in order to match the wheelchair to your resident’s personal dimensions. In doing so many of these issues can be alleviated. Remember: find a chair to match the resident NOT change the resident to fit the chair!

Please refer to the Seating and Positioning Guide to see what measurements need to be taken to ensure an accurately fitted wheelchair system!

 


 

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Ana Endsjo-1

Ana Endsjo
, MOTR/L, CLT
Clinical Education Manager LTC Division

Ana Endsjo has worked as an occupational therapist since 2001 in a variety of treatment settings. She has mainly worked with the geriatric population, dedicated to the betterment of the treatment of the elderly in LTC centers. Her focus has been on seating and positioning and contracture management of the nursing home resident. With this experience, her hope is to guide other therapists, rehab directors, nurses, and administrators through educational guides, blogs, webinars, and live courses in her role as Clinical Education Manager for the long term care division.

Categories: wheelchair positioning, Long Term Care

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